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APPLICATION FOR SANITATION PERMIT Permit No. ../. .�...f��- (Complete in Duplicate) Date Issued .i'�� (CY-� i 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 descr' This application is made in Compliance with County Ordinance No. 549. �+ ''r --------------------------------- JOB ADDRESS AND OC I . . '� _ _ Owners Name_. - ---- ----- ----- . ��" �-- •------- • --------�----- • - Address_.__ ___� r k _ rA� � _ - --------= .. Contractor's Name �7.(!-- _r' - < = � G� '�-: ------•--- Phone.... ' Installation will serve: Resi{denc� Apartment House ❑ Commercial ❑ Trailer Cour} [] Motel the, ❑ / Number of living units:�/___ Number of bedrooms ____ Number of baths __/�-. Lot size - F_ 3 _________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob�,K Hardpan ❑ Previous Application Made: Yes ❑ No,Z New Construction: Yes, No E] FHA/VA: Yes ❑ Ng.� TYPE OF INSTALLATION ipAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] P e from nearest well,,�,e=—_� Distance from foundation__ �_______Material__i Septic Tank: Distant `� No. of compartments----�-----------------Size___Y.�_ . Liquid depth-_- -- _�'Y_Capacity..----I d_--- Dis osal Field: Distance from nearest well____.._______- _Distance from foundation____________________Distance to nearest lot line----------------- Disposal .______________ .__. P ❑ Numbe}r of lines---------------- ------------------Length of each line---------- --------------- .Width of trench. Type of filter material-___------_--------------Depth of filter material-----------------------Total length-------------:---------------------------- Seepage Pit: Distance to nearest well__-____Distance from f ndation.i� _�______.Dista�ce to nearest lot line___.°------ _ --_Size: Diameter_ _ .___ i Number of pits-----Z------__------Lining material - __.__ .3,�--� --� ❑ Distance from nearest well_________________Distance from fondaton....------_._____ .Lining material-___._._.-____-___.___--_.______;`I _^. Cesspool: I. --=-----:- -------------------------- ---------------- --------------- Liquid Capacity---------------------------- a:' Disance from nearest building--------------------------------------_= Privy; Distan;Ce from nearest well_________________________________ _______________ Distance O to nearest lot line---------------------- ------------------- --------------------- -=------- •-- - Remodelng and/or repairing r'ing (describe), - � ---------- -- -------il=-----=--x--------""---•-,--•---- ------- --- •--------- ----------- ------------ ------------------------------------------ -------------------- —s ----------------------------------------- --------------------------------------------iF--------- ----------------•----•------.__-.---------•----- ------------------------- ----------------- `-----------------'-----------------------=-------------------------------------------•--------------------•------ == I hereby certify that 1l have prepared this application nd that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules 9A regul 'ons the n Joaquin L. cal Health District. } -�'--� ----------------------- - ---------------------- -- -----(Ow d/or Contractor) (Signed)- r a --- ------------ ------------------------- ---- (Title --- - ------- ._....- g = .------- - (Plot plan, size of) tlocafion o system in relation to wells; buildings, etc., can be placed on r verse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_��;� DATE----i_�----5 6 ------------------------ ---- ._ �---- ---------------------------------- ------------------- ------ DATE------------------------- ---------------•------------------- 1 BUILD NG PERMIT ISSUED-------- --------- - ----- ------------------------------------------- -----------------------------------------------------------------------•---------- --------- DATE------------------------------------------------------------ } Alterations and/or recommendations:__1`�--.___- �----""�"�1f,I------A'� ' - - 3- ---�---,: -s."` ---- - Q---- +-�'-`�''-`-R----� ---- -- ----- - - - - -- ---�� ---------------- ------------ C:------- r1 k -----61� --•--- ----------------_- ----------------------- ----- k If -�'------��-0------- � -,- ---------------- FINAL INSPECTION B,Y:----- K-5---- ----------- -- --- Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Stockton, California Lodi, California Manteca, California Tracy, Galifornia F ES-9-2M pevfsed 8-'59 F.P.eo. 'I