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APPLICATION FOR SANITATION PERMIT Permit No. 2_ -5 ��"3 (Complete in Duplicate) Date Issued ____ 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 here described. This application is made in compliance with County Ordinance No. 549. f��i JOB ADDRESS AND LOCATION.. ....... -------- Owner's Name---------- �,�r__-jd_A1r.7 '.er �T --------------- ----- ---- __ Phone. �{ Address--------x <1!.jt.,�:.. �_5-l--/��` s� � _�?1__�fia=..6�l/1�- �r '..... � ,f� l �l /-( aG�_.a-------•--- Contrar_tor's Name * /`~ ---. Phone------•--------------- xe.a�----------------------------------------------------- --Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: _`— Number of bedrooms '___ Number of baths _4&_ Lot size ------------------------------------ Wafer Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table,'�_ig ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay [:❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No Kr�'New Construction: Yes 0 No R--"FHA/VA.. Yes ❑ No 0-- 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___________________Ma+eriaL________________..__________..____..____._____- j(QS��/?y No. of compartments--------------------- ----Size----:---------------------------Liquid depth--------------------------Capacity--- ------------------ Disposa�>ld: Distance from nearest well.1,047--.-Distance from foundation___-7�_-_.....Distance to nearest lot line.--- -.�.- kr Number of lines-------�________-__._.________Length of each.line_-__--;Q7'�pp_______.___.Width of trench____ijr__#��___________________ Type of filter maferialZ.A/_'ea0ADepth of filter materia.I____./a__��__.__-.Total length___._.�_�_`f.-:-_____-_________-_ 5eepad4 Pit- Distance fo nearest well___-______Distance from foundation_�Wlf°r_____._.Distance to nearest lot line_',_____.__ Number-of pits----- --------- --Lining material---Z G�-/_f•--.Size: Diameter "___._____Depth_-_��..____'---_____________ - Cess o51. Disfaince from nearest well-----------------Distance from foundation.-.-----------------Lining material_--.______--.------_____-.__--_____ ❑ .% Size: Diameter------------------------------------ .Depth___________-:------ -=---------------------- ___Liquid Capacity Privy: well9als. r� Distance from nearest well__________________________________--- _--- Distance from nearest building_____.____________________-_--.---.---. ( 1 ❑ Distance to nearest lot line.-.-- ------- - - -------------- --------------- --. ------ --------------------------------------------------------------------. � Remodeling and/or repairing (describe)_______________ _ _______. _- ? - __..______r� C /._ _____�✓-fflC�l� ----i--- / � -----o ---- ----- ---- - - ------------------------------ --------- -------------------------------------------------------------------- -------- ---------------------------------------------------------•----------- --- -- - 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)---------------� - �� v-- ------ ----------------------------------------------- (�r Contractor) By:-------------------------------------------------------- - - ----------- ------------------------------- (Title)------ 6 ----- (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY---------------------- ---------- ------------- - --TC DATE------ --------- -------------- A BY----- -------------------------- i � --v-------------- -------------------------- ---------------- --- ---•------------------------ DATE---- --------- --------------- BUILDINGPERMIT ISSUED--------- ------------------------------------------------------------------------------------------- DATE--------------------------------------- ----- ------------ -- Alterations ---------------------- - Alterationsand/or recommendations---------- -----------------------------------------------------------------------•-----------•-••---------------- ------------------------------------------- --------------------------------------------------------- -- ------ - ----------------------------------------------------------- -----------------------------------------------•----------------------------------- ------------------------------------•-----------------------------------------------------------------------------------------------------------------------------------•-----------•--•---•------------------------------- -----------------------------•---------------------- ---------------------------------------------------•--------------------- ---------------------------------------------------------------------------------------- --------------------------------- --------------- ------------- ------------- ----- ---- FINAL INSPECTION BY-------------------- ----- -------------- Dafe----------------v -------- 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 v. Tracy, California ES-4--2M Revised 8-'54 F.P.Co.