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Jj APPLICATION FOR SANITATION PERMIT Permit No. _.--(L....1... (Complete in Duplicate) 1 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 descril,ed, This application is made in compliance with Coin rdinance �.p. S49. A li /� ±_... ___ _-------------------------- ------------- _ _______-____------------ .f .H---------- ._______.. __________-. JOB ADDRESS AND LOCATION. __ _ __ % Phone ---------------•---------•---------- Owner s Name--------------- ,1__.__ (� ---- - - - Address �'°f-•- - - --------- ---------------------• •---------------- Contractor's Name --------------- • -----• -- ----------------•-•------•--------�--- ---------------- Phone --------------------- ------------- Installation will serve: Residence Ra -"Apartment House F1Commercial E] Trailer Court [I Motel ❑ Other ❑ Number of living units: _1--_ . Number of bedrooms S Number of baths/ _ Lot sizefp- ----- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table �4A Ift. r Clay , Character of soil to a depth of 3 feet: Sand ❑ Gravel F1Sandy Loam ❑ ClY Loam [j Clay ❑ Adobe Hardpan E] Previous Application Made: Yes ❑ No New Construction: Yes p -No ❑ FHA/VA: Yes p �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weal____ ____ Distance from foundation ---- /00---------- Material_.:#€�5----------• No. of compar#merits------ �----------- - Size - 04; ---X Vp---•.Liquid depth---- --------- Capacity_1L9 --®_- Disposal Field: Distance from nearest wail - -.____ ---- Distance from foundation__IiP__�...... Distance to nearest lot line ___to_.____._.. Number of lines-__-____ __.-_ Length of each line____ e� Width of trench.__ ��___�___._________.___ -- ------------------- Type of filter material-!-- Depth of filter• materia!__/je-""-__-- Total length.....lt -- --------------------- • o �r �Q_-_7f'_. Ds�� a to nearest lot line --- ±________. Seepage Pit: Distance to nearest well- Distance from foundation_._ _. l� til Number of its____. Linin material_; '.,o Size: Diameter_-_ _ Depth ..... ___ ___ :- Cesspool: Distance from nearest well_______"___.__Distance from foundation___________________ Lining material ------- --�--"--- als. ❑ Size: Diameter"------------------------------------- Depth ------------------------------ ---------------------Liquid Capacity ----•-----------------------9 Privy- Distance from nearest well----- -- --------------------------------------- --Distance from nearest building --------------------------------- Distance to nearest lot line----------------------- -----------•------'----------------------- " ---- e r.^i ____________ Remodeling and/or repairing (describe).: ----------- --------------;" -,-------------------------------------------------------- r . .----- -------------------------------- ----------------------------------- - - ---- -- ! hereby certify tha+ I 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 District. ---- , -------- (Signed) /or Contractor} --- -{ f1 --- ---.. By---------------- -------------------{iitle} - (Plot plan, showing size of lot, location of"syst in relation to wells, buildings, etc., can be placed on arse s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------- DATE.r� _0 ------ - - .__ DATE- -------•--------------------- ----------------- i REVIEWEDBY ------------------------------------- ------------- ----------------------------------------------`---_------==--------- Alterations and/or recommend--tians-------------------------------'-------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------ ---------------- -------------------------- ---------------------------------------------- . -• --------------------------------------------------- --------Pi D ----------- ----- ---- ----------------------------------------------------- ------------ t_s--------., i - ------ -----------------------•----------------------- ------------------- ------------------------------- ---------------------------------------------- --- -------------------------- -- , Date__..--Y-/� � - FINAL INSPECTION BY:. --------- --------- t SAN JOAQUIN LOCAL HEALTH DISTRICT -a- 4F ..r...._. .r i 132 Sycamore Street •" ' • -814 North "C" Street 130 South American Street 300 West 0iStreet Y Stockton, California Lodi, California Manteca, California 1 + Tracy, California `y \ i r5 -9~2M Y .Revised 8-'59 F.P.Co. r