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r y APPLICATION FOR SANITATION .PERMIT Permit No /...... 101 (Complete in Duplicate) Date Issued -- This Permit Expires 1 Year From Date Issued _!�Xv --- - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he`rlain-descA-ed. This application is made in compliance with County � Ordinance No. 549. - JOBADDRESS AND LOCATION-------3---- f --------- A- ------------- C` �--------------•- •---------- --- ---------•---------------- c r If=_-rte- _K ------------------------------------------- -- - Phone__-- ----------------------- Owner's Name------------- � ' --Address----- r..... ------------- -------- ------------ Contractor's Name------------- ------------------------------------------- -------- Phone.. -•--�'--_---`--- — Apartment House ❑ Commercial [-] Trailer Court E] Motel ❑ Other ❑ Installation will serve: Residence ---x / �� Number of Irving units: __ -- Number of bedrooms ___ Number of baths _� Lot size -----------60 _____________________._-.--------.-- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Jg[ Hardpan ❑ Previous Application Made: Yes ❑ No R New Construction: Yes 5Z No ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_. Distance from foundation__./Q________..mat rial_._ ______________ __ __________ No. of compartments---- ______-Size___�K X_ S Liquid depa h_____�_.............Capacity______ _ pis s I Field: Distance from nearest well_-�._ _Distance from foundation---Z�.--------Distance to nearest lot line_________________ Number of lines_______ Length of each line______�v_ _________.Width of trench___-_. ��_____________ �.. �} _� g - ,f Type of filter material----�!''-"�--_Depth of filter material---------lf�_.__.Total length------------ ':,`�`Z-------------- r Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line----------------- F1Number of pits----------------------Lining material------------t---------Size: Diameter.------.---------------Depth........------------------------. Cesspool: Distance from nearest well--------------___Distance from foundation--------------------Lining material___.____.____-______---______________- ❑ Size: Diameter--------------------------------------Deoth-------- --- - ------------ -------- --------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-_____._____--------------____-------- -------.Distance from nearest building-------------- __________----_---- - -. i ❑ Distance to nearest lot line------------------------- --------------1------------------------------------------------------------------------------------ r+ Remodeling and/or repairing (describe):---------- ------- ------------ - -------------------------------------------------------------------- ---------------------- ----- -------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- --------- ---------- ------------------------------•------------------------------------- •---------- ------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,�Sptat aws, and rules and re lations of .the San Joaquin Local Health District. (Signed) "V ------------------------------------------ Owner and/or Contractor By--------------------------------------------Z-----------•--------------------------------- -----------------------------------------(Title)------------------- ----------------------- ---- --------- (Plot plan, showing size of loft, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------_-------- -- - DATE ) Kj REVIEWED BY---------------------------- ------------- -- -------------------------------------------------- DATE------------_------------/- 0 - --- --- BUILDINGPERMIT ISSUED---------------------- ---------- ------------------------- ------•- • DATE------------------------------------------------------------ Alterations and/or recommendations:----------------------------------------------- * ------------------------------------------------------------------•----------------....----------- ----------------------- ---- ----------------------------- ------------------------------------ --.:_----------- ----- ----------------------- ------------------------------------- ------------------ -- ---------------------- ---- --------- ----- ---------------------- --------------------------- - ------ ----- ----__- _ FINAL I NSPECTIODate-------.------r(0_-2_G ' ! � W 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 Revised 8-'59 F,P.Co.