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fir a.� �1 APPLICATION FOR SANITATION PERMIT wPermit No. _41;1 _.l a-�-3 (Complete in Duplicate) Date Issued __. This Permit Expires 1 Year From Date Issued e 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. 4 . . 4 ' JOB ADDRESS *AND LOCATION----- - ----------a � ---------- -------C /------------------ Owner's Name. --------� ---------------------------------------------------------- ----------------- Phone.----•---------•-------------------- Address....... / `� ��_...:._.... ----------------------•--------•---------------------- --•-•----------------------------------- Contractor's Name /V/ _---------•----------•----- Phone - Installation will serve: Residence Apartment House ❑ Commercial ❑' 'Trailer Court ❑ Motel ❑ Other ❑ Number of living units:'___1__ Number of bedrooms --/--- Number of baths __ --- Lot-size _.___..� --- -__��L -------------------- Water Supply: Public system k Community system ❑ Private E] Depth to Water Table -------- ft, Character of soil to a depth of 3"` feet: Sand F] Gravel [I Sandy Loam L] Clay Loam E] Clay ❑ Adobe�Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No�_ FHA/VA: Yes ❑ No PECIFlfATIONS: TYPE OF INSTALLATION ANDS ..,r. (No.septic tank or cesspool permitted if public sewer is available within 200 feet.) pfi 5H��nk: Distance from nearest well-----------------Distance from foundation_ _ _------------.-__.Material----.------..---.-.------..-----_ --.----------. � No. of compartments--------------------------Size----{"=------------ •--------Liquid depth--------- ---- ----------Capacity------ --------- - � I i a , Disprasa Field: Distance from nearest well---��.Distance from foundation.-/0 to nearest lot line__256 N Number of lines------_�_________ ______--.-------Length of each line------- __.__� ------:-.Width of trench__,_711 __-_---.----..--..- �`� -.-_--Total len th___._ _ Type of filter material of filter material g ��----------------------------•-- Seepage Pit: Distance to nearest well----/.VbA),�_---Distance from foundation___ _�__._ --__-MstanF to nearest lot ii-7 > -----•---•- ' Number of pits-__--/-------------Lining material-_ �A --- Size: Diameter__ ,3____.-----Depth-._?sSr+-_____..______ 4 Cesspool: Distance from nearest well--------------:-Distance from foundation--------------------Lining material_-_.--._..-.--.---__._-.----_---.- -. ❑ Size: Diameter------------- ----------------# Depth-------------------•--------------------------------Liquid Capacity----------------------------gals. Privy: Distance frominearest well.-.._.____f' __r_______________________.----Distance from nearest building.--.----_-_----.-_____-_----..____----. Q ❑ Distance to nearest lot line_ -----------`------------------------------------------------------ ---------=" f ---------------------------------- r Remodeling and/or repairing (describe) -' `/�� --- 1`f - ---------------------------------------------------------------------- ------------------ --•-------------- -- --------------- ---------•----------------- --- ---------- ------------------ -------------------------------------------------------------------------- I hereby certify that I have prepa this application and that the work will be done in accordance with San Joaquin County ordinances, State a s, d rule�nd r ulations of the San Joaquin LocalHealth District. --_�"./ -------- (Signed) [Owner and/or Contrac#arJ ----- f --- -- _ -- J----- -----------------{Title)-- By:--------------------------------------------------- { (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATIONACCEPTED BY- - - --"---- - --------- -- ------ - -----------------•---....... DATE-_ -------------_P.G.f --------------------------- REVIEWEDBY------------------------------- ----------------------------------------------------------------------- -------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE---------------------------------------------------.--------- Aiterationsand/or recommendations------------------------------- ------------------------------------------------------------------••- ---------------------------------------------------------- ---------------------- ---•-- ----- •--------------------- •------ ----------------- FINAL INSPECTION BY----- Date =� ' . -------------------------------------- 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 Tracy, California ES-9-2M Revised 8-'59 F.P.Co.