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APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in Duplicate) Date Issued __xe ' I 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 described. I This application is made in compliance with County Ordinance No. 549. !I �/, JOB ADDRESS ANDS L{OCATION__ r '' Y -- --------••----------------•--------...........------•---------------------------- Owner's Name---------__tom --- j----------•---------------•--------------------------------------------------------------------- Phone--------------..................... Address 6!I ---------------- Contractor's Name----------------- I ��---—!� '"`-y------•---------------------------------------------------•-------------•------ Phone----------------------------------- Installation will serve: Residence Zj--�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:-j bar of bedrooms _ _ Number of baths _.-_-. Lot size Z_Q� ------------------------------ Water Supply: Public system I' Community system ❑ Private Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe K1-'_H-ardpan ❑ Previous Application Made: Yes ❑ No Mr�_New Construction: Yes [e-"N ❑ FHA/VA: Yes [ o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well_______ _____Distance from foundation------la-------Mater�l---- --.�-- -------.---_------, [T/f— No. of co partments__--_--�-------------__Size. __J-_. - ---- Li uid de th....._. " */--------Ca aci --- I le Disposal Field: Distance from nearest well_-_-�- --------Distance from foundati _--__.......Distance to nearest lot line----6;�_r_____ [[' Number of,lines--------/------- _____________Length of each line______-----�--__--Width of Type of filter material__ / V46epth of filter material------- ______-Total length--------- _ See a e Distance to nearest well_/ _L1..`.._Distance fr m foundation-___ p 9 - ......Distance to nearest lot line___ Number 4 pits______Z---------._Lining material__ .Size: Diameter-,_--------------.Depth_-_1>1j i¢ Cesspool: Distance from nearest well-----------------Distance from foundation------------------_.Lining material------------------------------------- Eler------ ------------------------------Size: Diamet - Dep+h_- ` -------------------------------------------------- - Liquid Capacity--------- -----------------gals. Privy: Distance from nearest well-----------------------------------------------__Distance from nearest building___-_-.-_-._-.-------_-__-_-.-.._-_-._---. ❑ Distance to nearest lot line---------------------------------------------------------- ----------- I Remodeling and/or repairing (describe):-------- °= 'C � - -----• ----------------------•------------------------------ il. ----- ------ -- -- - �� ° - �� -- •- - ----- -- - - ------•----- ------ ---------- , /!rte------- ,,�,,,,}} I� I hereby certify that I have prepared this application and that the ork will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) �d�- ----- -(.�r Contractor) { I ------- RY- I- /��----y- ------(Title}-- ... -- --- -- ---- (Plot plan, showing size of lot, (location of syst in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY---------_t___A..0-- -- - ---------------------------------------------------------- DATE_------- --------------------- REVIEWEDBY ------------------------------------------------------------------------------------------------ DATE--------------------------------- BUILIJING PERMIT ISSUED____J-------------------------------------------------------- DATE------------------------------ Alterations ------------- ------Alterations and/or..recommendations:----------------------------------------------- -----------------------------------------•-----•------------••-------------------------------------------- ---- II -------------------------------------------------•--------------------- ------- ------------------------•--------------------------------------------------•--- -------------------------------------------------- I -------•------------------- -----•--------------------------------------------- ------------------------•------ Z FINAL INSPECTION Date-------(- __" � SAN JOAQUIN LOCAL HEALTH,DISTRICT 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.Co. .F