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APPLICATION FOR SANITATION PERMIT Permit No. -.1.1""""3_`"0-_- {Complete .1.1----3_10--- (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No 549. JOB ADDRESS A LOCATION__- ._ 00- ---- ---------------------- -- ----- - _1---------- Owner's Name_---- - ------ --------- --I----- --------------------------------------------- Phone-------`- ------------------------ Address----------------------------------------------- - -• - -- --------------------------------------- ------------------------------**-----------*-------------*---------------------- ------------------------- Contractor's Name__5x_e1x!�_"_ _ -'--e-— ----------------------------- •._. Installation will serve: Residence [Apartment House E] Commercial [-] Trailer Court C] Motel ❑ Other L1 Number of living units: -1....... umber of bedrooms -.2' Number of baths I— Lot size ----- ---f, 7- ---------------------------- Water Supply: Public system ��mmunity system El Private [-] Depth to Water Table 40 ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam [:] Clay Loam E] Clay F] Adobe E-lHardpan El Previous Application Made: Yes 11'" No New Construction- Yes ] No [] FHA/VA: Yes El No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool pe'rmitfed if public ewer is available within 200 feet.) Septic Distance from nearest well?qZ --Distance from founclation-1-0-1----_-__.Material-"-_._ _._`'__--- No. of comparfmens-s_____7--'___.----- - - clepth--- ------------Capacify_.___x_469 I 6f3 Disposal field: Distance from nearest welI.A"_UA1_Di '_ 's_7an,e r,m foundation---- --------Distance to nearest lot line--- Number of lines�. I Length of each line--- -,Width of trench__________________ -----------q+.t--- ---- Type of filter mlatril_ hCG{___Depth of filter material------- Total length.- Avv_*_______"_.-_________-./_ --I 4_ Seepage it: Distance to nearest well-14-on-U-—------Disfance frc�rn foundation___10..........Distance to nearest lot line------- ------ Number of pits[.--I---------------Lining maferial_TZjcf,_k,___ Size: Diameter------ Depth--------2-d---------------- Cesspool: Distance'from nearest well-----------------Distance from foundation------------------- Lining material-----__-._.._.._____.____"_.-_-____. t Size: aterial-------- ----------------------------- Size: Diameter-A------------------ ------------Depth ---------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well - ------------------ ----------- --------- --Distance from nearest building-------------------------------------•--- ❑ to nearest,lot 1i -----1---------- ----------- ------------------- -------I------------------------------------------------------------------- Remodeling and/or repairing (cesctibe)------- __ -_ ---------------- --------------------------------------- °� ------------------------------------------------------------I------- ------ ---- ---- - --Y ------- ------------------------------------------------------------------I------------------ ------- ---- - ------------------ -------------- - --I ---------- ------- ----------------------i--------- ------------------------------------------------------------- - 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 rules and regulations-of the 'San Jjweiiu'n Local Health District. .7(Signed' ------------------------------------4C1w*eVRMd;6or Contractor) By:---------------------------------------------------------------------------- - -- -- -- - -------------------(Title)---------------------------------------------- --------------- r ion 0 s Ar (Plot plan, showing size of lot, location of system in r ion to wells, bu' ings, etc., can be placed on reverse side). Contractor) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------MR_.Q_e�------------------------------------ ------------------------------ DATE------ /Y_7 15 -------'---------------------- REVIEWED BY-------------:-------------------- j 11 --------- - ----I-------------------------------------------------------------------------- DATE-------------------- BUILDING PERMIT ISSUED-------------I i/I , ---------------- ----------------------------------------------------------------------- DATE--------------------------------- Alterations and/or revommendationl------------------------------------------------------ ---------I------I-----------------------..........•----....-------------..-----•--------.- --------------- ---------------------- --- ------------ ......... I- ----------------------------------------------------------------------- ------------------------------------------------------------------------------------- r ----------------------;��x--------6_�_--------- fR =-------------- 1Q��- ---------- ---------------_------------------------------------------------------------------------ ----------------------------------------------------- --------- ------------------------ -----------------------------------------------------------------------------------*---------------I------- ----------------- ------------- -- -- ------- - ------ ------ --------r----- -7---r------y--------------------------------------------------------------------------- ---------------------------- --------------- FINAL INSPECTION-BYr--------- --------- - -- ------ Date---- ----------7-------------------- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Sou'A American,streof 300 West Oak Streef 132 Sycamore Sfree4 814 North "C" SfrGeT Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 FT.CO.