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APPLICATION FOR SANITATION PERMIT Permit No. v� (Complete in Duplicate} Date Issued This Permit Expires 1 Year From Date Issued pplication 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. iq-dA) : j�" Z- `7 JOB ADDRESS AND LOCATION------- S7-'�-`------------- - -V—Z-44-x ' ------ �T Owner's Name------ - - ----•--.------A"-Y---I---e-- --- ------------•------•--------------------------- Phone------------------------------------ Address--------------------------------- ------------------•----------------Address--------------------------------- ----- /�f ! ''--------------------•----------------------------------- ------------------•--------------•----------------------- Contractor's Name--"---------- �` Y-----------e-t . -------------------------------------------- Phone.. - ..._.. Installation will serve: Residence ❑ Apartment House ❑ Commercial []/ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ----- la-----•-------- Water Supply: Public system 10' Community system ❑ Private ❑ Depth to Water Tables _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ] Hardpan ❑ Previous Application Made: Yes ❑ Noo New Construction: Yes/ . No ❑ FHA/VA: Yes ❑ NoN TYPE OF INSTALLATION AND SPEC IFICATIONS:----�- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--- __.__Distance from foundation--------_--_-__-Material_--_--.�___________________ No. of compartments.---------2------------Size--------------------------------Liquid depth---------:55`----------Capacity :l -- Disposal Field: Distance from nearest well_._=!'G'---__Distance from foundation--_-_:� ___---_.Distance to nearest lot line_ _______.__. Number of lines--_.---_-_�_-_--___---_---____Length of each line______ ___-.I___-. Width of trench--------- .__Y- _---_-_._." -- Type of filter material- p_,!2__!1___Depth of filter material-_--_Z-----__Total length-------.-/-3 Q'________________ 4) Seepage Pit: Distance to nearest well-------'r�__`�.__'_Distance from foundation--_-- .'.Distance to nearest lot line__;/-_/'•..... Number of pits-------2----- Lining material--- 1�Cil Size: Diameter------- --- _- De th---------A4-.__.------------- Cesspool: 'Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------ L] ___-___-__---- ._______ (� [] Size. Diameter------------------------- ---------------------------------------------------.-Liquid Capacity-- ------------ 9als. 1 5t\ -- ---------Depth - Privy: Distance from nearest well_ :__'__`_-__- "----- Distance from nearest building-----._.-------------------------________ ❑ Distance to nearest lot line--------- --------------------------------------- Remodeling and/or repairing (describe):------------- ------------------------------ --------------------------------------------- -- -------------------------------------------- ---------------------------------------------------------------------------------------------------------•----------------------------------j------------------"---------------------------------------------------------. ------------------------------`_----------------------------------------------------------------------------•----------------------------'---- ----------•---------------------------------------=- ------ 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 rules and regulations of the San Joaquin Local Health District. (Signed) -------- -�'-`�-4'"----- t ------------------------------------------------------------------------{Owner and/or Contractor] 8Y: - --------------------------------(Title)------------------ ------------------- - - ---- -------- (Plot plan, showing size of lot, lcart', of system in ation to wells, buildings, etc., can be placed an reverse side. FOR DEPARTMENT USE ONLY q APPLICATION ACCEPTED BY-----_77—t-R-C)------------------------------------------------------------------------- DATE----- �� { ' r�-------------------------- REVIEWEDBY--------------------------------------------- --------------------- -------------------------------------------------------- DATE------------------------------------------ ----------------- BUILDING PERMIT ISSUED----------'----- DATE..---_---•-- --------- ----------- --- �= "{= '- r !11`� r -�-�--=-------------- %�` `= ----------------- Alterations Alterations and/or recommendations,.-------_________ A -- ------------------------ - � � T r y J1'r r /� �r r r ,. .,mil F INAL INSPECTION BY:. f �� l =�✓- :' f/ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 13$=Syeamore Street 814 North "C" Street Stockton, California Lodi, California Nkenteca, California Tracy, California Es-9-2M Revised 8-'59 F.P.Co.