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y APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in Duplicate) Date Issued ---- This __-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 insta4l the wor herein described. This application is made in compliance with County Ordina ce No. 549. { 708 ADDRESS AND � ----------�- ' � Phone------------------------------------ - Owner's Name------ ------- Address __ � � yA ✓� I/� ------•-----------•-•------=-;------•••---------- Phone------------------ ---------- Contractor's --------- - Cotactor's Name ---------------- � - ^ "` ' Mofisl Other Installation will serve: Residence ❑` Apartment House ❑ Comme_rcial ❑--Trailer Court ❑� ❑, ❑ Number'"of baths - Lot size ---Ile------;'5_T._/_;_W/-------------------- Number of living units: __I_ Number of bedrooms .� Ile Water Supply. Public system ecommunity system ❑ Private ❑ Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑. Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No g?'O' New Construction: Yes gj- lo ❑ FHA/VA: Yes ' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) I � ' Septic T Distance from nearest well _ ---Distanc from foundation---- Septic tea�_L�_ 1 of compartments_____.------------Size ---------Li uid depth___ Capacity---- No. __ ..: q - �'----- -- Disposal Feld: Distance from nearest weal___'__' �--.-Distance from foundation-__/----------Distance to nearest lot I ne�__� Length of-each line____,X�d `�_--Width of trench.___ �j�-- ----------• �- Number of lines__________ _______ __ p y� of filter material i ._ Q Depth of filter material _._Total length______ � ------------------- Type E �. . -f— ____.____.D•stance to nearest lot line�.i! ___.____ I Seepag it: Distance to nearest well---__"`��-"_.Disfiance fr m fo dation____�� p' Linin 1t 'i-.......Depth---- --------:.. Number of its._._ ._ gKma er�al Q�-. ---Size: Diameter__ _ Cesspool: Distance from nearest well-,;__rte':_-----Distance from foundation-------------------.Linsng material__.__._______----------------gals. ElSize: Diameter-------------`f ....... ---------Depth----------------------------------------------- ----Liquid Capacity 9 • - . Privy: Distance from nearest well---------------------------r-------------------._Distance from nearest building-------.,-------------------------- .�-. --------------- nee Distance to rest lot line-_ : =---_--"`---_ = == == _---- i I ti 1 Remodeling and/or repairing (describe):----------- -" " I 4 ----------------------------------------------------------- --------------- ------------------------ 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 regulations of the San Joaquin Local Health District. (Signed). --------- ----------- ------------ --------- --------------------- --------------------------------- ---------(Owner and/or Contractor) or) lay, showing six-- of lot, ------flan of system m r'--------------------- ------------------- (Title]......ti, x` (Plot hi P elation to wells, buildings, etc., can be placed on reverse side). FO DEPARTMENT USE ONLY I. APPLICATION ACCEPTED B _._._ - ~- ------4DATE-- - =- ---------------------------------- -REVIEWED BY--------------------------------------------------- -------------------------------------------------------------------------- DATE--------------------------------•-•-•-------------------- BUILDING PERMIT ISSUED------------_-----------------------------------------------•----------------- ------- -------------- DATE-------------------------------------------- ---------------------- - Alterations and/or recommendations:------------------ -------------- ------------------•-----------------•----------------------------------------------- ---------------------------------- --------------•-----•-------------------- ----------------------------------•-----------------•- 1, ---- •------------ ------------------•--------------------------------------------- ----------- -- - - ----------- -------- 44 I Date------- - ----------------------- FINAL INSPECTION BY=-- -=�__ - �-� -�►-� --�- -- -�-�- f• L SAN JOAQUIN LOCAL HEALTH DISTRICT—T.- a J S t32 Sycamore-Street } .a ti \ 844 North "C" Street 130 South American Street 300 West Oak,Street Stockton, California y Lodi, California Manteca, California �Tracy, California ES-9-2M Revised 8-'59