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,rPermit No. .._.1. :. ..1. APPLICATION FOR SANITATION PERMIT" .' (Complete in Duplicate) ,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. 011 JOB ADDRESS AND LOQATION. ' / .__ _ . Owner's Name--------- ........ --/------•----------------------------•---•-•--• -------------------------------------- --------------------- Phone------------------------------------ - Address----- A------------ --�f�� f '��- ----------------------- ---•-•--------•----------------•---------------------•------------------ Contractor's Name_ �-------------------- - ---- Phone Installation will serve: Residence 4J Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A-___ Number of bedrooms ._._ Number of baths y-- Lot sizer t------------------------------------- Water Supply: Public.system ❑ Com to ity system ❑ Private. ,] Depth to Water Table 7-47 ft. Character of soil to a deam of 3 feet:` Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam.] Clay ElAdobe❑ Hardpan. Previous Application Made: Yes ❑ No ❑ New Construction:_Yes ❑ ..No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) * --T p— _ e from.foundation-----------------------Material------------------------------------------------------- Ca --------_--------- --------------------------- Se tic _ _ � .._. � _ __ aisle: ,__ Distance from_near.est well_________________Distanc- _ _ ._ f ; - r _ No. of compartments- - --------------- Size--------------------------------Liquid depth-- ---- ----- Capacity----------------------- a Distance from foundation._a47----------Distance to nearest lot line__-,-.-_-__--- Dis oral Field: Distance from nearest well/49 - Number of lines__-•. ---------- -----'---- -Length of each line---//[7.'. "�---.-Width of trench- ----- .------------� a 4 Type of.filter material�__4 Depth of filter material_1_1.-------_ r _____.Total length _ � Seepage Pit: Distance to nearest well----------------------Distance from foundation--._____----_--___.Distance to nearest lot line--._-_------....- t L ❑ Number of pits.--------------------Lining material-----------------------Size: Diameter-------•--------------Depth--------------------------------- , Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material-----.-------------------------- _.- Size: Diameter--------- - ----------------- -Depth------- ----------------- ------------ -- -Liquid Capacity----------- -------gals. . Privy: Distance from nearest well-__.-__---_-- ---------------------------------Distance from nearest building=------._______.____________------_----- ------❑ --- Distance to neacese lot line - F - -- ---- -------------- �. ,Remodeling and/or repair}ng (desc b --'--------------'------------------------ ------------------------ --------_------_ -- ----------------------------_.L I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health Dis+rict. (Signed)------ '�'`"` iL} ----------------------------------------------------------------------------(Owner and/or Contractor) By:------------ f -------------------------------------------------------•------------(Title)----------------------------------- ---------- -------- (Plot plan, showing size of lot, loca+ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT-USE-ONLY - --l- APPLICATION ACCEPTED BY rte------------------------------------- DATE..t�` 'Y-G REVIEWEDBY------ ----------------------------------------------------------- ------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE--------------------------------------------- --------------- Alterationsand/or recommendations:-------------- ---------- -------------------------•--------------------------•--------------------•--------------------------------------- ------------------------ ------------------------------------------------------•-------------------- ---------------------- ----------,---------- ----------------------- ------------------ ------------------ FINAL INSPECTION BY, / � --------� Date.... m- 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. -