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IS � J I APPLICATION FOR SANITATION PERMIT Permit No. .....�_�_7S� (Complete in Duplicate) /Q� 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 ATI -- 1. =-3- �•---11_ I Owner's Name--------------- - -' --- ------------- = ---- Phone Address----- ----- --_--' ----------2�4� �rkn Contractors Name-------------------- ~�--"='�------ -- Phone --------•------------------------------- Installation will serve: Residence jr-_A_`partment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: Number of bedrooms _';4► Num4r'of baths _'___ Lot size ----------------------------- Water Supply: Public{system k--community system ❑ Private ❑ Depth to Water Table -kA ft, f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam C] Clay [-] Adobe 2`57ardpan C3 Previous Application Made: Yes ❑' No �ew Construction: Yes ❑ No-4R--THA/VA: Yes ❑ No [ � TYPE OF INSTALLATION AND SPECIFICATIONS: ,. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) '. ptic T Distance from nearest well--------- -----Distanceom foundation-J-d----------M tesiai____&_e_ No`Iof compartments-------_;L1---------.__Size! . _XV02.:Liquid depth-----f=--�i--------------Capacity-----�do-90---- Disposal FField: Distance from nearest well-...-_�'r'_._Distance from.foundation____6?--------- to nearest li�_ ; _r_-----_ Type of fi ter material� / Depthhofffilter mlateri _-��..___Total hlength french ��__---�______________-_----__ Q 11 of --- Stance from foundatian�__________________Distance to nearest lot line___________.._. I Seepage � Niumabee of pits rest wieli_-----Lining material--------------- ei Diameter---------------- --- Depth Cesspool: Distance ff•om nearest well---izf�---------Distance from foundation--------------------Lining material-------------------------------------- ❑ t Size: Diameter-------------------------------------De th----------------------------------------------------Li Liquid Capacity !p q p Y • -- ------gals, Privy: Distance from nearest well--,----.b.u------------------------�._-_-_--__Distance from nearest building______________________-_-_..___----... m ❑ Distance to nearest lot line------ '` -� -- '"` - - -- -------- - Remodeling and/or pairing (desc`ribel--------------- �lr[�If�P.__ ----.--- ._._ ----•- - -- - -------- `� -•-----= = ` = Q-A ==- --------- 1 ---------------------------------------------------------------------------------------------- ---------------------------- _t I hereby certify that I have prepared.fhis application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the an Joaquin Local Health District. I (Signed)---------------------------.- 4 ' ------------------t-----------------------------( Contractor) t By:-----------------------------'- ------------------------------ �� -------------------(Title)- /� l/v---°-------------------------- (Plot ------------- --------- (Plot plan, showing size of lot, location of syst relation to wells, buildings, etc., can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED.BY---- -------------------------------------------- DATE------------ I d REVIEWEDBY------------------------------------ -------- ------- --------------------------------------------------------------------- DA ---•- ------------------- ------------------------------- BUILDINGPERMIT ISSUED------•--------------------------------------------------------------------------------------------- i DATE----------------------------------- Alterations and/or recommendations:---------------------------------------------------------._.....-. _._--_ - ---------------- -- -- - ----------- � - Zr--- f �! -P ------------- ; I . -------------------- -------- ------ --------•----------------- ----------------- ------------•----------------------------- ------------------------------ ------ ---------------•-------- -------------------------------------------------------------------------- -------------------- --------------- ---------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: - ----.- Date-------- /g 1 Z-------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT l 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street t Stockton, California Lodi, California Manteca, California Tracy, California {{ E5.9-2M Revised 8-'59 F.P.Cc.