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APPLICATION FOVSANITATION PERMIT Permit No. ... (Complete in Duplicate) Date Issued ..-_/dI/`` - a This Permit Expires 1 Year From Date Issued X 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 -------- -CATION: �� -- ---L -�' '' -1------- •----------------•------------------------- y - - -- - Owner's Name - fry " - Phone G Address--------- - ------------- -------- --------- -- ------ Contractor's Name______ ____ __ ____ ----- -- Phon _ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trail r Court ❑ Motel Other ❑ Number of living units: " '" Number of bedrooms-- Number of baths _�___ Lot size __. � ��/---------------------------- i . I Water Supply: Public system"� Community system ❑ Private F] Depth to Water Table�.�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobej< Hardpan ❑ Previous Application Made: Yes ❑ No�' New Construction: YesZ No ❑ FHA/VA: Yes ❑ N9 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic T nk: Distance from,nearest well-________--------Distance from foundation--------------------Material-____---__________.___----______________--._.__. No. of comportmenu Size. Liquid depth---------------- - ------Capacity----------------------- No. geld: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line__________ �. Number of lines----------------------------------Length of each line------------------------------Width of trench--------------------------------•-- F Type of filter;material----_-___.______________Depth of filter material---------------- .----Total length---------------------.-_______.__'____-_ 4 :N 1 ' Seepage Pit: Distance to nearest well _J---"--Distance from f ndation__,,�Q_.______.Dist nce to nearest lot ii5e__ _______--.- ---Size: Diameter _ fr"-.-__.be th_as tom{ Number of pi}s___ --__-"""-__Lining material _ _.__ _ � - P � n Cesspool: E Distance from nearest well-----------------Distance from foundation.------------------ Lining material--------------------------- _-____._. ❑ Size: Diameter------------------- ------- ----------Depth-------------- --------------------------------------Liquid Capacity----------------------------gals. Iii - Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------- ❑ Distance to nearest lot line----------------- ----------- - --------------------------- --------------------------.---------- Remodeling and/or repairing (deScribej:,�__/0,-/ I' ----------- ------------------------------- ---•-----------------•----------- -------------- ---- I hereby certify that I have p par d this app'cation d t the work will be done in accordance with San Joaquin County ordinances, tate la nd rules nd ulations o the in J uin Local Heal} istrict. 46 (Signed)_ --- ----- - - - ---- ----(O nd/or Contractor) • -- I' ------------------------------------------------------(Titl -... ---.--- . -- ------------ (Plot plan, s e of lot ion of sy em in relation to wells, buildings, etc., can be paced on evers ode). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__1' r-.-- -------- -------------- DATE_: , " - ------- t - v REVIEWEDBY------- �: DATE--------------------------- --_---------------------- BUILDING PERMIT ISSUED-------- DATE Alterations and/or recommendations------------------------------------ ----------------------------- ---------------------------------•----------------•---------------------------- ----------------------------------------------------- i ----------------------------•-------------------------- ---•------- ` _ ------------•--------------------------------------------------------- ------------- ---•- ------- ---- FINAL INSPECTION BY:.-----''-- ----------- ��E Date `_ __ _G 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 6-'59 F.P.Co. —- IIR�..