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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) -. This Permit Ex fres 1 Year From Date Issued Date Issued .__._ �?�..._i✓,l 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. aIc�1 7 �j �; JOB ADDRESS AND L CATION----------- ------ --- ------- ---------- --- Owner's Name-------- = ��----- -- --- ---- ---------------------------------------------------t ------------- phone--------------------..---------- Address----------------------------------- - ------------------------------- 3 Contractor's Name----------- ��.- -4y 15=- rt----------- �z-��-�� Installation will serve: Residence ® Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living.units: Number of bedrooms _„ _ Number of baths __ Cot size -------- _--._-__-____--._ Water Supply: Public system Dd Community system ❑ Private ❑ Depth to Water Table Zd ft. Character of soil to a depth of 3 feet: I Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe ❑� Hardpan ❑ Previous Application Made: Yes ❑ No a New Construction: Yes (R No ❑ FHA/VA: Yes ❑ No a TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------- Distance from foundation.___-_-_lMaterial------ 2"-WA"-_-. [4 t _t '. �No. of compartments---------'v__------Size----,l�l'_,3_X- _--Liquid depth-------- =-- --------Capacity----- __ r F Disposal Field:.. Distance from nearest well__,r .rte__-Distance from foundation------ ---_.Distance to nearest lot line...... ��._... ® Number of lines--------------------:7x-�------Length of each line------------- 3`1'.�E?-------;Width of trench-----------?f________----._ Type of*filter material__,09!:r c�___-.-_-Depth of filter material__1�f'..__......Total length----------- ------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation----............___.Distance to nearest lot line-__-_.------ \\�� ❑ Number-of pits----------------------Lining material----------------------.Size: Diameter_---------------------Depth--------------------------------- (V Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--_______--__-________..____.-.^_....�`'�W,1 ❑ Size: Diameter--------------------------------------Depth------------------------------r------------•..:.-_LiquidrGapai itY gals. Privy. Distance,from+nearest=well " ----:- -_¢_-_'__-_._-_ .-.-Distance from nearest building �• ,❑ Distance to nearest lot line---------------------------- Remodelingand/or repairing (describe):_ ----------------------------------------------------------------------------------------------- ----------------------------------------------------- --_-----•----•---------------------------------------------•-------------------------------•------•----------------------------------------------------------------------------------------------- ---- - -------------------------------------------------------------------}.R_.....T-_-__-_.--.--_-____-----_____-----__--------_____---_-___._--_-__---_--__-__-_--..---__----.._._---_-_----_---_-__-------__-_____.--____.-..---_ � --------------------------------------------------------------__-----------_-----------------------------------____--_-_-_--_-_____-___________________________._..______._____.__________._____.._--_-.------_._-_.-......._._ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County .ordinances, State lays, and rules and regulations of the .Sari Joaquin Local Health District. i [ 9 ]-- - ---- ---- ----------- ----------- -------------------------------------(Owner and/or Contractor] Title Br -------- ---------------------------------------------------------------- ----------------------- -tr ) - ----------------------------------- --------------(Plot plan, showin size of lot, location of sysfem in relation to wells, buildings, etc., can be placed on reverse side). �. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY r"� Y DATE------ �------ ----------------------------- REVIEWEDBY ----------•------------------------------------------------------------------------------- DATE------------------- --------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------------=--------------------- Alterations and/or recommendations-----------------------------------------------------------------------------------------------•--------------------------------=------------------------------ -------------------------------------------------------------•---------------------------------- ------ ----------------------------•------------------------------------------------------------•------------------------••- ---------------------------------- ------------------ --------- -----------------------------------------------------------••--------------------------------------•---------------------------•------•--------•--- ---------------------------------------------------------------=-------------------------------------------- ---------------------------------------------------------•------------------------------------------------------- = ------------------------------ ----------- - -------•-----------• ._.. - - FINAL INSPECTION BY------------------ C '�5 Date--.------------------------ ----------------------------------------------------- SAN JOAQ IN LOCAL HEALTH DISTRICT i 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.Cc._. �•