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( ' APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �` v This Permit Expires 1 Year From Date Issued Date issued ` `_----- 1 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 Ordin ce No. 54 JOB ADDRESS AND LOCAT f ; - wner's Na ----- _.-----•-• ------- _ Phone_ Address • " -- ---- -- ------------ - ---- ----- --------- Contractor's Name_"" _____ -•--------------------------•-----•- - ----- - --- ---------T4 ,------ Phone �f Installation will serve: Residence Ap ment House E] Commercial ❑ Trail r Court ❑ Motel Other E]Number of living units: ----- Number of bedrooms Number of baths -cm.-t- Lot size ____ Water Supply: Public system ❑ Community system ❑` PrivateX Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [] Previous Application Made: Yes ❑ NOV New Construction: YesNo ❑ FHA/VA: Yes [_1No,� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank,or cesspool permitted if public sewer is available within 200 feet.) i '� r S tic Ta Distance from nearest—well-- No. earest well_"___Distance from foundation--------------------Material------------------------------------------------ -------- ______________ ----------------------------•---- No. of compartments -------- ----Size------------------ - ------•Liquid depth------------------------.Capacity------------------•---- j isppoossal Fi d: Distance from nearest well_ #--Distance from foundation_/C} ________Distance to nearest lot line___ {f Number of lines----- ____ Length of each line__-_- ? 41 ------- ----___---_.Width of trench-___ "---'-----_ -------------- ype of filter material-------------------------Depth of filter material-----------------------Total length--------•--------:--------------- -- Seepage Pit: Distance to nearest welL__�1�Q`4'____Distance from f ndation____�Q�-r---Distance to nearest lot line____*--_• Number of pits_--__--/------------Lining materia---Size: Diameter.__.3,3 `r ` Cesspool:. Distance from nearest well___`____--.-_---Distance from foundation._- ____ Lining material __.___-__ -.- "' ❑ Size: Diameter Depth -------------------- - ------Liquid Capacity---------------------------gals. Privy: Distance from nearest well___'_________________________ ------------------"Distance from nearest buildm g ❑ Distance to nearest lot line ------------------------------------- 9 � p - 9 � ribe a emo elfin nd re a�rkn dart ----- - ----- ------- -- ------------------ --------------------------- ------------------------ - I hereby certify that I have prepared this applicat' n and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and egulati of San aquin Local Health District. (Signed) - ---- r #ed fircaner and/or C or) (Plot pian, sh of o tion of stem in relation to wells, buildings, etc., can be plaon r verse FOR AEPARTMENT USE ONLY x APPLICATION ACCEPTED BY----------- --- __ DATE_ ---------------------- REVIEWED BY---- ------------=---------------" --------- ------------------------------- �------ --------- ---�----- --- ----------- � DATE-- ------ IJILDING PERMIT ISSUED ------------ --------------- - - Alterations and/or r ommgndations--------------- ------------------------------------------------------- --- ------ ---- ------------------------------------------------------------- -- ------- 1 = ----- - ---------------------------- ------------ - FINAL INSPECTION BY:---- - --- -- _-- -- ---------------- Date--- .. SAN JOAQU N LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streot 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.