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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued -----�-'�- 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. JOB ADDRESS AND Lx.441--'S'---Y- Owner's Name--------- -•_- '% ---------- Ph / Q � - ----- - - --------------------------------- on Address.,----------------- Contractor's Name----------- �' � -----------� ------ '� --------•''------------------ -------------- Phone--------='=.•---•- ----------------- Installation will serve: Residence ❑ Apartment House omm '� ial r •' _ ° ,a `� �� ❑ Trailer Courf•❑' Motel ❑- Otfier ❑ Number of living units: -�..7^.- Number of bedrooms.�- - Number of baths 3-- Lot size _Ap --------------------- Water Supply: Public system Gommunifiy system ❑ Private ❑F Depth .to Water Table 'Oeft. _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ `-Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 9�'�New Construction: Yes ❑ No PP-'"FHA/VA:.Yes ❑f—' No Z4-- TYPE rTYPE OF INSTALLATION AND SPECIFICATIONS: `•: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) A tic _ ,Tank: . Distance from nearest well--___ --..--.__-Distance from foundation--------------------Material ---.._---.-----_-___--.--___---_-- � 1 � No. of compartments Size---------------------- ------Liquid depth--------------------------Capacity----------------------- Disposal Field: -•--------------- DisposalField: Distance from nearest well-._.*---rrrT---.Distance from foundation------14P-----Distance to nearest lot line----��_ Number of lines----------�.-r__________-_ Lenp#h of each line._- _� --------Width of french.__ �� Total lengthy_ Type of filter material_/ C1Z De th of filter material_./ r �— , Seepage Pit: Distance to,nearest well_------�._.._-----Distan`c'e fr�9 foundation-_-.- Q--_--.Distance to nearest lot line----------------- c Number of pits._.--_/------____Lining material-----l�.��_.Size: Diarneter'____�_-�___Depth.___ _t1' _`----__- Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material-------------------..__------__ ❑ Size: Diameter.---"---------- ----------------------Depth----------------------------------------------------Liquid Capacity --------------------- gals. \ Privy: Distance from nearest w - : ell------------------------------- -- '__'__* - Distance from nearest building__------____-----_.-._------_ ❑ Distance to nearest lot line------------------------------- - -- k--_------_--- ----------------------------------------------------------- --------------- Remodeling and/or repairing (describe)------------------- �'� 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 laws, and r es and regulations f the San Joaquin Local Health District. _ (Signed) = ( Contractor) By:---•------------------------------------•-•---------- - --- Title A44_?(-------------- -- -( ) t �r--'"-- ------------ ----------------------- (Plot plan, showing size of lot, location of syste 1 elation to wells, buildings, etc., can be:placed on reverse side). FOR DEPARTMENT USE,ONLY APPLICATION ACCEPTED ----------- -- DATE-� - ---�� --- •�--------- --- - --- REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE------ -- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE - ----------- A terations and/or recommendations------------------- ------_---- -_ -------------•--------------------------------------------- -------------- ------------------ ------------- ------•------------------------------------ ------------------------------------------------------------------- FINAL INSPECTION BY: r. -------------- --- Date.... SAN JOAQUIN-LOCAL HEALTH DISTRICTA 130 Soutft-American S+reef300 West Oak Stree+, ti J32 Sycamore Street,j L 814 North "C" Street Stack+on,;California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P,Co. 4 J 4�