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T . APPLICATION FOR SANITATION PERMIT Permit No. !� (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. r This application is made in compliance with County Ordinance No. 549.-, F ---------- JOB ADDRESS AND LOCATION-------------� �21 __ CG_(�.L.�_�_��---- �-----------••---- CA Phone. . 1 Owner's Name---------------------- ------ ----t-------•------•w=.�!__�-------------- ------------ - ----------------------------- ---- - 7 - v------ .7 ' -rtf --------- Contractor's Name ------------•--- ��"C- <)---------- Phone--------_------------ - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 3 / 7 x_1.5---------------------- Number of living units: __� Number of bedrooms __ _____ Number of baths __...___ Lot size .______ _ Water Supply: Public system � Community system ❑ Private ❑ Depth tp Water Table - f+- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes*, No 1�( 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.) ' `- ------Distance from foundation____�42-------- ___-Material Septic Tank: Distance from nearest well___.___ - -----"""�----""�---""" "�----��-��-�---�""-� �( W No. ofcompartments ��– Size &X__9X_47Liquid clepth------ -�--- ---------Capacity OC� Disposal Field: Distance from nearest well_..'_____-Distance from foundation___-__e_Q-------Distance to nearest lot line�/___------------------ Number of lines---.------`3------ --------- -Length of each line--------— ------------.Width of trench_----------•----------------------- Type of filter material__�?_A^.4-Depth of filter material___ 1- ------Total length________________ --------------•- I Seepage Pit: Distance fo nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____-..______ V El { (Number of pits----------------------Lining material-----------------------Size: Diameter---------- ------Depth----------------------- Cesspool: - Distance from nearest well-------------------Distance from foundation---.-----------------Lining materiaL___.______-_-"____________________ Size: Diameter-------------"-----------------' .D,epth_---•---- ='. --,`------------:-----------------Liquid Capacity--------------------- ------gals-. Privy: Distance from nearest well_________-"__._ '-----------------------Distance from nearest building______-_---________._____--------------. v Distance to nearest lot line---------- ----------- -- ----------------------------------------------------------- ----------------------------------- Remodeling and/or repairing (describe):------------ -----•---------•----------------•-•--------•--------------- --------- --------------------- E = ----------•---------------------------------------- -----------• --------- --- I hereby certify that I have prepared, his application and that the work will be done in accordance with San Joaquin County ordinances, Stag law , and rules and xeg tions of the San .Joaquin Local Health District. L6�� ____(Owner and/or Contractor] -------- (Signed),/----•----------------------------- ------------ y---------------`------------ -------------------------- Tale ----------- ----------------- -- ---------------- By:----------------------------------------------------------------------------------- plan, showing size of lot, location of system 1n relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` ------ DATE---------_�_ APPLICATION ACCEPTED BY--------------------- --- - -- -- -- ------ � f-e/� �---------- ---- REVIEWED BY DATE----------- -------•-•-------------- ------- - ITBUILDING PERMIT-ISSUED---------------------- --- --------------------–-------------------------------------- DATE__ i Alterations and/or recommendations:-------------------------------- ---------------------------------- -• --- ------------•---- -- ----------•-------------- ----------/- -- ----------- ------ - ---- • --------------- ------- - ----- -- ------------- r �: -------- -- - ------ - - - --- ----- ------ o- --- -- ---- FINAL INSPECTION BY------------- - ---- ----- ----- Date-----— �f --------- ------------------- --------------- 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.F.Co.