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APPLICATION FOR SANITATION PERMIT Permit No, (Complete in Duplicate) Date Issued ._..G This Permit Expires 1 Year From Date Issued f 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 IN - 549. CATIO --- --- -JOB ADDRESS AND Owner's Name- ..........�--�'��C•�C•---------------------------------•- - -------------------------------------------------- Phone.................................... ` Address ---------40FO-- -----76----••-- -- _---_--_- Contractor's Name-,444 +x ------------------------•-------•-------------------_._- ----- -------- ---....... Phone................................... 'r Installation will serve: Residence 00 Apartment House ❑ Commercial ❑ Tra'ler Court ❑ Motel ❑ Other❑ tt / Number of living units: _1_____ Number of bedrooms _�+9___ Number of baths/- __ Lot size ............................. Water Supply: Public system ❑ Community system ❑ PrivateW Depth to Water Tableft$o'_ ft. M Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan.❑ Previous ApplicationMade: Yes ❑ No,] New Construction: Yes*I No ❑ FHANA: Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellrP---------Dista�nfp from foourndation_.,/p............._,__-___,_.________Capautylt�Ofl____..__. Disposal Field: Distance from nearest well_✓d________Distance from foundation..._t.Q............Distance'to nearest lot line_j....___-_. Number of lines. _:_•, __ ength of each line-__1`1aoj.� 0Width of trench Type of filter materi ' _ i Depth of filter materiaL4r.'------------Total length-.JA............................... Seepage Pit: Distance to nearest well ___________________Distance from foundation....................Distance to nearest lot line---_------------ Number _____________-Number of pits-- ------- -___---lining material-------- -------------Size: Diameter--____-_ --.. ._--___ DeP th................................. 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-- ------- -- ---•--------- --- ------- -•-_- ---- ------ -- ------• -----... ------------------ Remodeling and/or repairing (describe):......................................................................................................................................................... -----------------------------------•----------------------•---------------•--•-_------------------------------------•--------------------•---------------------------------------•----•-------------------------._...-------- --- ------------ ------- -------- --------- -------- -------------------- ----•------------------------------------------------••--- -------- -•-_--- -•----- ------------------ I hereby certify that I have prepared this application,and that the work will be done in accordance with San Joaquin County ordinances, State lips, andrule and regulations of the San Joaquin Local Health District. d (Signed)------ -- --------- -----•--- -----•--- . -._:...- -- ---•-- --••--,-- --------- -------_---------------- - (Owner and/or Contractor) By:------- -------- -------- -------- -----------•-------------------- -------- -------- ------- ------ -----(Title)---- -- = ------ - --- ------ j (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------------------------------------------------------ DATE.;-17.40--- •-----------•----- ------- REVIEWEDBY--------------------------------------------------•-•-----•- -------•--_.._----• -•----•••------•---••--••--•----•---- DATE ---------•------ ----- ---•- ----- BUILDINGPERMIT ISSUED...............................--------•---------------------- •-------•-----•-----------•-_ DATE...........................-•..............._• ------_•-------•- Alterations and/or recommendations:------------------- ------•-----------------------------------------------------........................................................................... FINAL INSPECTION BY: •---- -------- Date----- --------------------------------------------------- SAN - -------- ------ - ------- ------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California lob, California' Manteca, California Tracy, California 8-9-2M Revised 8-'59 F.P.Co.