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APPLICATION FOR SANITATION PERMIT — Permit No. U i • F (Complete in Duplicate) { This Permit Expires i Year From Date Issued : Date Issued ___.. _ (•� Application is hereby made to�the San Joaquin Local Health Disfrict.for,a permit to construct and install the work herein described, This application is made in compliance;wifh County Ordinance No. 549, ' JOB ADDRESS AND LOaCAQTe<ION-__�___'_lE��_/ Be-1 = &�Z.__-____.___ -s---- W • ----------------- - - -------- Owner's Name---- - Ph one Address-----------•-- ------••----------------------•-------------•••------- ------------------_----- Contractor`s Name-------f---- - -- � r +"Pho---------- __ ne, Installation will serve: Residen e ❑ Apartment House ❑ Commercial Tr er rt sf y ❑ _❑ ~Mofel ❑ Other Number of living units: ----- Number of bedrooms I�Iurn6er- of bath____._' Lot size ____. -------------------- Wafer -------•----------- Water Supply: Public system ❑ Community system ❑ Priva S.e#❑-�.SDept}h to Water Table_,-' ft. Character of soil to a depth of�3 feet: Sand Grav l ❑ 'Sa cJy•Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ il. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance fro'm nearest well__-_�-Distance from foundation_ -___ __�-- Material-----------`-- p No. of compartments� ___--, -[7z.___�---.--Size__ _ " ----- --------------Capacity_ 11 'Ci (/ Dis osa reld: Distance from nearest well_5O-------Distance from foundation- /O k Distance to nearest lot line_________________ Number of�lines-_____- _'-_ - i Length of each line__�i : Width of trench Type of fiir materiaL_5 _ - YpDepth of filter material___f -------- ---Total leng --Seepage Pit: Distance tInearest well___________________ _Distance from foundation--------------!____.Distance to nearest lot line_.____________.__ � ❑ Number of 'Pits---------------4=Uning, material____-___- ----Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance fiiom nearest well_________________Distance from foundation---------___.__.___.Lining material__-_--._.____.-_____._ ❑ Size: Diameter--__-_' _. — -De th--" p - -------= --------•-------------Liquid Capacity------------------------ gals. Privy: Distance from nearest well--------- -- -----------------Distance from nearest building ❑ I Distance to�'nearest lot'line-_ — -- '" . ` ----------- --- -- -- ---------- L Remodeling and/or repairing (descril,e):--- ----,--,�'P. /lL?� � �Le � -------- f ------- ------------------------------ •-------------------- �-�-------•------------•------------------------•--------------- -------------------------------------------------------------------------------------------- j 4 ----------------------•-----_-----------------•--------------------•------------------------------------- -- ---•-- ------------------------ I------ --------------ql:------------------- --------------------------------- y'o' I here6 {r+ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances tat Iaws,land rules a regulations of the San Joaquin Local Health District. -,r(Signed) /�/ ' d � ` Owner and/or Contracfor) r liy-- --- --- -----•--•--- � {Title) -------------- ---- -- ---- - ------- �.(Plot plan, showing size of lot, location of system ' relation to wells, buildings, etc., can be placed on reverse side). f r uO . 1 1 FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTEQ BY1--------- - --- --------------------------------------------------------------------- DATE /,REVIEWED 'BY----'--------------- )f----- ----- --------------------------------------------- -------------------------- DATE -------------------------- i. , BUILDING PERMIT ISSUED------ ----- ----- --------------------------------------------------------------- ---------------- DATE--------- t. Alterations and/or'recommenda:tionc_____ --- -- - -.----------------- ---------------- --- -------------------------------- -------------- ----------------- -----•---------------------------------------•------...--------------------------------------------- --- ----------- FINAL INSPECTION BY:.- ------------------------- Date--------- lr SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Was+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, C' , Stockton. Manteca, California �. Tracy, California ES-9-2M Revised 8-'59 F.P,Co.