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APPLICATION FOR SANITATION PERMIT Permit No. ................. (Complete in Duplicate) pa}e Issued �`__ �`� ( ` _ This Permit Expires 1 Year From Date Issued ---- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatic is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__ J®-q- �o�_��---- --------------------------------••----.._......_...... ------------------------------ Owner's Name-------EARL---GILSTR.)P---•---------------------------------- ------------------------------------ Phone----------•-••---------------------- Add ress----------------------AD DIIA�--- Contractor's Name-------- ...._ -C ~ "C Phone... Installation will serve: Residence []?/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -]---- Number of bedrooms._ Number of baths L____ Lot size __-._.__--_____.______ -------- Water _______Water SuPPIY• Publics stem El system Private !d' De fh to Wafer Table 4-5—ft. Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (Hardpan ❑ �/ w Previous Application Made: Yes El No I!� New Construction: Yes V No ❑ FHANA: Yes ❑ Nof� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted {;public sewer is available within 200 feet.) Com. Septic Tank: Distance from nearesf�5 n ound !2-----Distaation_____/�_--------.Ma erial__ XNo. of compartments------- 2--------------Si -- ---___- -----Liquid depth------- -------------- Capacity-------G� ` Disposal Field: Distance from nearest-A.-510--..__Distance from foundation----__,!--------Distance to nearestof line------ __�_'r'. trench-.-.Z- Number of lines______________ _.----_..____Length of each line_��-"�'�0"�Width of trench_._. _. ___ Type of filter material___ Depth of filter material----)9_1`_--------Total length-------- __________________ Seepage Pit: Distance to nearest welt_ Q______Distance from foundation----I ------------Di t!ce to nearest lot line___ _r_ Number of pits----- ___/t--Lining material_~_.Size: Diameter______________________ Cesspool: Distance from nearest weiL________________Distance from foundation----- ..___.______--Lining material-------------------------------------- Ej Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------..__________-____-__.____.._. ❑ Distance to nearest lot line------------------------- --------------------------------------------- %------------------------------------------------------------ Remodeling and/or repairing (describe) I } *--------------------�---------------E--1---------------•------i<----- _ -- -- - - A ----- -------- -- _` ti � � - - _A -------------- ----- --------------------------------------------------------------------------------------------------------------------------0------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule and regulations of the San Joaquin Local Health District: (Signed)----- IZ/lC ----- ---- -4"'----------------------------------------=-----------------------------------------------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------trifle)-------- --:------ ---------- --r---- .- - -- ------------------ (Plot plan, showing size of lot, location of system in rely}ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - =_ APPLICATION ACCEPTED BY---7!71:;� ---------------------------------------------------------------------- DATE .°' `^' " F74------------------------- REVIEWEDBY------------------------------------------------------------------ --------------------------------------------------------- DATE---------- ----- -- - ---- BUILDINGPERMIT ISSUED------------------------------------------ --------------------------------------•.------------------ DATE------------------------------------------------------------ Alterations and/or reco mendations:------------------------------------------------------------------- --------------- --------------------------------------------------------------------------- ' --------- ----------- -------------- ---' - F--------- ----- �eke..------- ` - - * ^ -�c ---- ------------- ------------- --------- _- - __e. ---------- --- ---- - - - -- - ----------- - - ----------- -- FINAL INSPECTION BY:---- '- �------------------------ Date �7�r - CJ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Re,ised 0-'59 F.P.Co.