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APPLICATION FOR SANITATION PERMIT Permit No. .__/ �. / (Complete in Duplicate) Date Issued ---- 77��1`S-L & This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permitxto construct and install the work herein-1.escribed. This application is made in compliance with County Ordinance N . 549. �. , „r.- v Z f o JOB ADDRESS AND L ATIO --- �/ •-- -= '----------------------------------------------------------------------------------- { Owner's Name-------- - -- --------- Phone------------------------- ---------- Address----------------- / ----------------- = f ��, ------------------------------------------------------------------------------------------------------.. Contractor's Name • - y_ s ------- ------------ = Phone Installation will serve: Residence Apartment House ❑ Commercial ❑Y� Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __ mber of bedrooms{. _ Number of baths __I__ Lot size .�iD_!1(_r.1A9011_______________________ Water-,Supply: Public system' _ Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a.depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe vle<ardpan ❑ Previous Application Made: Yes [) No & INew Construction: Yes ❑ No 9?/THA/VA: Yes ❑ No Ry- TYPE OF INSTALLATION AND SPECIFICATIONS: ,. (No septic tank or cesspool permitted if public sewer is availa6le within 200 feet.) 5 fiic -Fa ' Distance from nearest well------------- Distance from foundation--------------------Material____.___._._________-_ _________..__________- �07;V No. of compartments----------------- --Size---------------------------- ---Liquid depth----------------- --------Capacity-•---- ----- -- Disposal Feld: Distance from nearest well--all-[/;.!_Distance from found t' _ __fes Distance to nearest I t line-id��' r ----------- �� Number of,lines______________ g � // __ _ _Len Length of each line_____ _ -___r___.______.Width of trench____ ___ __.___..__.__._ De th of filter material �j____-__Total length __ _�_____ Type of filter material- �- i p g _------ %a e F Qistarce to nearest well__ __ __g: __-Distance f m foundation _- �P't,� �� _; * � ___:IJis# �e to nearest lot line__ ______-. (f f Number"of jts---- sf . i p �_____ __.___Cining material, _ ._size: Dia meter _.__...___Depth_.~!___.._ Cesspool; Distance from nearest well-----------------Distance from foundation___________ _ _______Lining material____. ________-__-_-.___________ �, ❑ Size: Diameter-----�- ----------------------- Depth---------------------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest wefl------cy-----_--------------------------------Distance from nearest building----------------------------------- k Distance to nearest lot line = ------ ----- --------------------------------------------------------------------------------------------- .❑ Remodeling and/or repairin (describe)------------------.-- _---------___ -- m 1 - ____ _._ ________________________________________ ___.______---_.____-__=__________________-_________________________________-_-_-_____________.______.________.__----- -_------.____---_____ ___________________ _ ___ _ _ _ =' 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 r lations of the Sayf Joaquin Local Health District. (signed) i -- -- - --- -- ------ ---------- --------------------"---(�r Contractor) BY: - --- ----- "_�-----------[Title)----- • [Plot plan, showing size of lot, location stem in relation to we Is,'kiuildings,etc:, can be placed on reverse side). s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ =•---------,<-W------------------------------------------------------------ DATE----�7--`c95------6 REVIEWEDBY----------------------------------------- -- ------------------- ---------------------------------------`-------------------- DATE-------------------------------------- ---------- --------- BUILDING PERMIT ISSUED---------------------------------- --------------------------–---------------------------- --------- DATE----------------------------------------------------------- Alterations and/or repo mm `rd a tions:-------___- -- ------- ;1 - -4- ---------- ------------------------------------- FINAL INSPECTION BY:..-._ -`-_L --- ..-___-- Date---- -------- . SAN JOAQUIN,LOCAL HEALTH DISTRICT, r� 130 South American Street 300'West qak Street 132 Sycamore'Street 814 North "C" Street f Stockton, California Lodi, California' '� Manteca, Californ e_+ Tracy, California z ES-9-2M Revised 8-'59 F.P.Ca.