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APPLICATION FOR SANITATION PERMIT Permit No. .121 (Complete in Duplicate) Date Issued ....�5_7 This Permit Expires I Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfail the work herein described. This a plication is made in compliance with County Ordinance No. 549. 9-4, JOB ADDRESS AN,D ...... CATION Owner's Name_____ __ - W. ------------ ----------------------------------- ------------- Phone----------------------- Address-------------------- ------ il(j I -------------------------------------------------------------------------------------------- Contractor's Name____,-_1#v0_&mu------------_------------- ------------------------------------------------------------------------------------*------ Phone---------------------------------- El Installation will serve: Residence Apartment House 11 Commercial ]a Trailer Court E] Motel El Other El Number of living units: -------- Number of bedrooms.____---_ Number of baths, Lot size Wafer Supply: Public system K Community system F ] Private El Depth to Wafer Table.- ft, Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam [:] Clay Loam C] Clay 1-1 Adobe ] Hardpan ❑ Previous Application Made: Yes El No El New Construction: Yes El No Ej FHA/VA: Yes ❑ No ❑ TYPEOFINSTALLATION AND SPECIFICATIONS: -- (No.se' fic fank"o7r -cesspool bi feet.) P rmiffed if public sewer is available within 200Z '_ Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Materiaf Cl No. of compartments-- - ----Size-------•----------- -- - ---Liquid depth------------------------ Capacity----------------------- Disposal Field- Distance from nearest well-____._____---- Distance from foundat;on--------------------Distance to nearest lot line----------------- ❑ Number of lines---------------------.-----_------Length of each line----------.-------------------Width of french Type of filter material--------------------- ---Depth of filter maferial-----------------------Total length___._.______________:-____- ----------------- See ge Pit: Distance to nearest4weIV4"--------t-----Distan(te from foundation__-$10_'.-____.Distance to nearest lot -------- Number of pits____.______________Lining materiali? --------.Size: Diameter_1y_+__?*_j---Depth--- ------------------ Cesspool. Distance from nearest weil-----------------Distance from foundation--------------------Lining material____.____--_----__._ ❑ Size: Diameter--------------------------------------Depth----------------------------- --------------------Liquid Capacity----------------- ------_-gals. Privy: Distance from nearest well--------------------------------------------_.-Distance from nearest building----------------------------------------- El Distance to nea' r'est ]of line Remodeling and/or repairinig (describe):--------------------- ----------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------I------------------------------------------------------------ -----------------------------------------------------I----------------------------------------------------------------------I----------------- ----- - ------------------------------------------------------------------------------------I-------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance$, S"flaw and rule Cnd=ry regulations of the San Joaquin Local Health District. .g (Signed)- ------- ------- --- - -- -------- ----------------------------------------------------------------------- --------(Owner and/or Contractor) By: ------------------------ ------------------------------------- --------------------------- --------- ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on "reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_AX' - ;A�V;,4*0_�------------------------------------------------------------- DATEr771 --- -- � REVIEWEDBY-------------------------------------------- ------------------------------------------------------:------------------------ DATE------------------ -- ------------ ----------------- BUILDING PERMIT ISSUED --------------------------------- ------------------ Alterations and/or recommendations_____________________ ------------------------- ecommendations:------ ----------- - ----------------------------------------------------------------------------------------------- --------- -------------------------- ---------- --------------------------------------------------------- --------------------------------------------------------------------------------I----------------� __1----------------- ----- -------------------------- .1----------------------------------- ------------------------------------------------------ -------------------------------------------------------------- ------------------------- ------_-------------- ---------------- ---------- ----------------- ------- - ------------------------------------- --------------------------- ----------------- --- c -- I------------------------------------------------------------------- FINAL INSPECTION BY. / 1 ------------------------- Date_W SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5.9-2M Revised 8-'59 F.P.Co.