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APPLICATION FOR SANITATION PERMIT Permit No. _.../.,1 (Complete in Duplicate) ' This Permit Expires 1 Year From Date Issued Date Issued _---_ O 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 LOCATION-1----7SG :-' a �r l _ .--- Owner's Name---te __hb---- ------------------------------- -------L- Phone----••-------------•---- Address------------------_-S -P. -•-•-----------------------•-----.......--•--- Contractor's Name-------- lY S-----Z` ------------------------------ ----------------------------------- Phone----------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units' 119' ,Number`of bedrooms -_ - Number of baths ----L Lot size -..+ q-� Water Supply: Public system 25Community system.❑ . Private ❑ Depth to Water Table _' ft. Character of soil to a depth of 3 fel t: Sand E] Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay E] Adobe Hardpan ❑ Previous Application Made: Yes ❑1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA; Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS r, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ ________Distance from foundation_{_D---_--- _-.MateriaL. No. of eompart encs-------- ------ Size----- �c�--- Liquid depth----- /- -------- ----Capacity_ _ Disposal Field: Distance from nearest well.._----.--Distance from foundation--- _---------Distance to nearest lot line_________________ Number of lines"------------ __ 7 -A- .i � �_____..__Lenth.of each line=__-�"----------- ---Width o trench_- y See a e Pit: Distance to nearest Well-----r-- --_-_-----Distance from foundation---��_.�.._..__.Distan a to nearest lot line` -- Type of filter material..... Depth of filter matenal_____�_$`__---------- length___--g 6------- ----------------------- Seepage --- __. _________________ Number of pits_:..-._2-_---___Lining material-__._--_`TIr_+ _ ..Size: Diameter___ x_4-_----- th-_----.._�--Dep ' ------------------ Cesspool: Distance from nearest well-----------------Distance from foundation-----------_----------Lining material-----___---__-___--.___..__-_____-_. ❑ Size: Diameter.- ----•-----------------------------Depth---------------------------------------------------iLiquid Capacity----------------------------gals. Privy: Distance from nearest well-__________________________------ --------------Distance from nearest building----------------------------------------- `14 ❑ Distance to nearest lot line..........__ ._ rr - ------------ --------------- ----' ---= Remodeling and/or repairing _ --- ✓---/ !f�C_ rt_,�- �C i (s ----------- -------- --------------------------- -------------------------------------------------------------- ------------------- - Ji- --------- -------•-----•----------------------------•------------ ---------------------- --------------------- ------------------------------------------------------------------------------------------------------------------------------- - ----- 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 a d reg ations of the San Joaquin Local Health District. (Signed) ------ ------------------------------------- - --------------------- - (Owner and/or Contractor) . ) �-------------Title - ------------- By:-----------------------------------••-- ---------------------•--- 9 P - - --- --- -- - - ----- ----------------- - ------------------- - ------------------------- ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------y----- ---------------------- ' t-C-A---------------------------------- DATE--------- REVIEWED BY dam_ — 1p U --------------- -- DATE--- ------------- ---------------------------- --------------------------------------------- BUILDING PERMIT ISSUED ------------------------------------------------------------- ----------------------- DATE. Alterations and/or recammendations:. - ---------•------- -------------------- ../-' �i --------------------- -------------- ------------- ---------- _- -------------- ----------- ---- ---------•---•----�--- - --�-- - --•---•--- =-�---�� ---�- -- - ---�•--l—.1 - ---- "`rte •------------------------------------------------------------------- -- -------------------------- ----------- ------------ ------------------------ - -------------------------------------------- --------- ----------------•--------------- FINAL INSPECTION BY:. -- _ -- -------------------- Date_._ �/ _ -- f ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California I Es-9-2M Revised 8.'59 F.P.C.. f