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Permit No. .1.... Z..r r � APPLICATION FOR SANITATION PERMIT �----- (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 herein described. This application is made in compliance with County Ordinance No. S49. r JOB ADDRESS AND CATION _ .",::-�� ------------------------------ ------------X. ------------- a� ..- Owner's Name - ---- Phone = _ " ------------ Address-------------------------- -�' � �-� - ----- = /- ! G 1 ,, ] ---------------------- Phon R' Contractor's Name---- ---- € - •' Installation will serve: Residence Apartment House ❑ Commercial [3 Trailer Court [3 Motel ❑ Other E] t Number of living units: _ __ Number of bedrooms ____ Number of baths -_ __ Lot size ____ ___� �� .------------•-- .. Water Supply: Public system ®Community system ❑ Private ❑ Depth to Water Table 's ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [I Clay Loam [I Clay ❑ Adobe Hardpan E]Previous Application Made: Yes [] No ga i`lew Construction: Yes ElNo El IFHA/VA: Yes ElNo El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .S 'psicP4,4 : Distance from nearest well_________________Distance from foundation_.______-_---_____.Material---------------------_--------------------------- No. of compartments--------------------------Size---•-------- Liquid depth_-------------------------Capacity----------------------- Dispbs Distance from nearest well.----------------Distance from foundation--------------------Distance to nearest lot line------------------ (' ---------Length of each line------------------------------Width of trench----------------------------------- , Number of lines--°-----------------"""-- � Type of filter material_ __ : Depth of filter material----------------- -_-Total length------------------------------------------ W t Seepage Pit: Distance to nearest weDistanc17 oJ_m�iioundation_. ___._-_. . ance� o nearest lot line_ _ ___-_ Number of pits------ Lining mater's "..Size: Diameter____c � _"-."""-Deptn -.__;� "�""""..."-"-.- T Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material---_-.__--_______-______.____--_-____. ❑ Size: Diameter--------------------------------------Depth,----------------------------------------------------Liquid Capacity----------------------------gals. ; Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-_______._.-_-_______________.___----- ❑ Distance to nearest lot.line---------------------------------------------------------------------------------------------------------------------------------------------- a Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------- -----------••------------------•--------••------------------------ --------------------------------------------------------------•----------------------------------------------------------------------------------------------------- --------------- ----------------------------------------- -------=-=----• ------------------------- ------------=--------------------------------------------=----------- ----------------•---------------- --------------- ----- I hereby rtify"that I Have prepared this application'and that the work will be done in accordance with San Joaquin County x ordinance$, S e I s, a les and re lations of the San Joaquin Local Health District. (Signed) ------- --- --------------------------------- wner and/or Contractor) ------------------------(Title)- A - -----.."-------------------- - R s (Plot plan, showing size of lot, locatio of system in relation to wail , buildings, etc., can be placed on reverse side). ;_4 f 777 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- R �"� '-------- ---------------------------- DATE----,--" ---CA-------- REVIEWEDBY--------------------------------------------- •------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUI LDI NG PERMIT ISSUED---------------------------------------------•-------------------------•----------------------------- DATE-------------"---------------------------------------------- Alterations and/or recommendations:------------- --------------------------••--------------------------------------------r-------------- ------- rc. ------------------- "" -_ - = -1: =----- --- --------- ------------ --------- --------- r ---------- --------------------------------- --- ---------------------------------------------------------- ------- ---- ---------------------------------------------------------------- --------------------- i�r Gr ------------------------------ FINAL INSPECTION BY�,-.-C'_._��._',1��'._.-"--- -"----- Date-. I SAN JOAQUIN LOCAL HEALTH DISTRICT i BO South American Street 300 Was+ Oak Street 132 Sycamore Street 814 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California ; ES-9-2M Revised B-'59 F.P.eo. r . I