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APPLICATION FOR SANITATION PERMIT Permit No....�..._:.....5. ` (Complete in Duplicate) % ,..: ,...-• µ - Date 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 application is made in compliance with County Ordinance No. 549. JOB -ADDRESS -:AND LO.9ATION______�_______________ t ------ # Owners Name=�1. •--•--C".' ------------- Phone�Q �' l ...._.. Address--------------------------------------- - '_ _ Contractor's Name_____________________'_"":_ - --�"...r----•----• ---------- ---------------------------------------------------------------------------- Phone_'% Q-S_jy_6-�-- { Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ t Numberfof living units: ; _ Number of bedrooms __.�__ Number `of baths ___1__ Lot size __-_ _ y -- j - - �... x- ..�.� 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 ❑ Hardpan ❑ Previous Application Made: Yes ❑ No Kt New Construction: Yes ❑ No 54 FHA/VA: Yes ❑ No ]� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer -is available within 200 feet.) Septic Tarik: Distance from nearest well 4'4-_'tDistance from foundation__,,f'_a------ Material ______ .- ._. �' No. of compartments ---------- _i.y/tSize�_,_.f_._ __`Liqui �pth--:Dista to nearest est lot lin Disposal Field` Distance from nearest well-. 0__' � Distance from foundation_____ , ----- -- i_- Number of lines---••_--- -_---Len th of each line_________ .X-------Wi Width of trench------------- -__�__________ z 1 Type of filter material___ ' fie -of filter material___-__ __ _- Total length_-____._____�/_ j -^__c-____________ { Yp _ - -- p, ��-------- Seepage Pit: Distance to nearest well___________*___Distancfrom.foundation________________._..Distance to nearest lot line __.______.______1 ❑ Number of pits --------------------- )Lining 'md-e,D;ai----------------------- Size: Diameter-----------------------Depth------------:r------------------- nce from Cesspool: � � SDizeaDame}e nearest e�i-.=_�___.DepthDistance from foundation--�-Ct--4----Liqund Capacity -------------------------- } # _ ..� _. _- Privy: Distance from nearest.well_________________4._V_ .._-__.._ -------------------- icerfrom nearest bu`ilding'_:_�_=":________""'""""__. � Distance -to nearest lot line !` r----------------------- ---- a ------- ----------------- Re odeling and/or repairing '(describe)_ ------------------------------------ -�-----------------------------�-- --- r ---• - ------•-----------•------------------------------------------------ ------------- -- ---..----- -------------------------------------- ------------- ----------------*------------ ---------==----------------------------------- = '' ' ~=--------------------=` = I hereby certify that , l .hav" pfe pared this application and that the work will be done' in accordance with` San Joaquin County ordinances, State laws„and rulesand regulations of the San Joaquin Local Health District,,-- �w (Signed) ----- {Owner and/or Contractor) -- S.--------------------------------- -------------------------------------------------------------------------- Title ------_------------------------------..._ . Y',(Title) (Plot plan, showing site of lot, locatio of system in relation to wells buildings, etc., can be placed on reverse side). { t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------- ._----- ► } ----- --- - -- - 1 _ DATE ------------------�'- ---�-�-----�'� ---- - REVIEWED BY ------------------------------- ------------------------------------------------------------------------------------------- DATE-_--: r� BUILDING PERMIT ISSUED----------------------------=----------------------'=----- ---------------------------------------- DATE------------------------------------------------------------ Alterations an or-recommeridations'-� '"`^4 _`s�si►~'"a°- ---- - - ----- 2d _� -' Ste” `�'C 1. -cFz-------^- �`1� ---- / --- -ltz ------ _ = —� r= �2_n C .�----•-- —Z? ��. r- =�---------ff-�S fy - ---------•---------rr-�� �—�--- FINAL INSPECTION BY:----- -- -- --- . >_ Date-- ------- - :-2- _ 2�------ -- ------------------------------ I C'� /6 i SAN JOA UIN LOCAL HEALTH DIST 130FSouth 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 B-'59 F.P-Co. I