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Permit No. ----- -APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) Date Issued ___ 1-�;! j 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 describe . This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION --------- - - ----- ---- - ----------------------- P I --- Owner s Name ---_._ ---------•------------------=-----•-----•------•------•-•----------------•--------- Address ------------------------ ------Address-----•---•--------•----- Ph ne - - ------------------ Contractor's Name---------------- --------- - Installation will serve: Residence Apartment t-ouse[]"'•Commercial ❑ Trailer Court ❑ Motel ❑ Other ` - Number of living units: ____-__. N mber of bedroom--- Number of -baths ________ Lot size __ Water Supply: Public system . Community system ❑. Private ❑ Depth to Water Table __-_._- ft. Gravel Sand Loam ❑ ' Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Character of soil #o a depth of 3 feet: Sand.❑, - r ❑ Y on: Yes ❑ No FHA/ VA: Yes ❑ No El Previous Application Made: Yes [D No El '`;New Constructi❑ TYPE OF INSTALLATION AND SPECIFICATIONS:" (No septic tankorcesspool permitted if public sewer is available 200 feet.) . —,ell -..;4 . --- pfii ank: Distance from nearest well-_-______------- Distance from foundation---------------- --Material________._.------.----.--------- Capacity I �'%f c Q� No: of compartments_- ---------------- Size--------------------- ------- Liquid depfiph�� - p Y r` a o�pistance to nearest lot line - i osaI Feld: Distance from nearest well.. Distance from foundation_.-- 1(, -- •- Wsdth of trench___ ?otline -- --- Len thof each line____, t -Number of lines --------Z----.-- -- 9Total len th�-----------------•Type of filter material-- �;Depth of filter material__. --- ----- gDistance to nearest well_ -----__-------------Distance fr fo dation--_-_-.-___._..____.Disfiance to nearest �--- _.-__ -- Sepage.Size: Diameter___-��----- Depth__,r-..- ,,-`�`J Number of its--_-_-._' Lining material___ --- l cess ool: Distance from near st well ---------------r, Distance from foundation__. -^_:_L g 1 Linin material---- ------= p ----=De th_- '------- --- -------------------Liquid Capacity--------------------- ---gas. \ 11 ❑ Size: Diameter------------------------------ p ;ti -••ii — - Distance from nearest building-----------------------_--_----_._---.._. i Privy: Distance from nearest well- �______ ______ ____ ❑—•Di_staeto nearest lot fine__- -: _- ------------------------ w l -' =--------------- Remodeling - and/or rewiring (describe ---------------- --- --------_.__.-_-.-- ---------- - ------------------------------- 1 - __ I hereby cer#ify that I av prepared -f is application and that Local 'alt a done in accordance with San Joaquin County I I ordinances, State laws, a fe and regulations of the $an Joaquin Local Health 'District. -------- --------------------------- and/or Contractor) ned (Sig gY: ; _� x = (Titl ------------•-------•-------------- -- - -- (Pyo# plan, showing size of lot, location of system in relat on_ao:.w.ei fs;� uildings, etc.,_can be placed on reverse side). ` FOR DEPART1"' ENT USE ONLY -1 DATE---- -r �f.Q---------------------------- - APPLICATION ACCEPTED BY------------- ---- CFl ------ DATE ------------------------------------------------------------ --- BY - -- - -- . � /---- ----------------------------------------------. DATE------------------------------------------------------------ BUILDING ------- ------------------------------ ----- IBUILDING PERMIT ISSUED-- =' - =:-"- - ---------------------------------------------- Alterations and/or recommendations: =-------- ------ -- - - -------------------- -------------------------- •-------------------------------------- ------ --------- ,�--------------- - ------ ---------------- - ------------ - - ----- Date------------------ ------------------------ FINAL -------------------FINAL INSPECTION SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 134 South American Street 300 West Oak Street Trac California Stockton, California Lodi, California Manteca, California y� ES -9-2m Revised 8-'59 F.P.CO,