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APPLICATION FOR SANITATION PERMIT- Permit No. �7 (Complete in Duplicate) 3 This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION- ••• , - •-- ............ ••-• :---.041,t, ' Owner's Name•---, ,/1,=ts..... Phone.... Address--------A- -1•Vony..-.--1 ___•----- Contractor'sName------ Phone _.... Installation will serve: Residence J� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ___ Number of bedrooms -:3... Number of baths J___. Lot size .._ . 'I`'__ ____________________ ____ Water Supply: Public system ❑ , Community system ❑ Private D4 `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 New Construction: Yes ❑ No ❑ ;FHA/VA: Yes E No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellrJ d_�_.-Distanc fro found ation...a.0 ......Material �_�' PqNo. of compartments_-_ - Size. - - '± Liquid depth_---' ..---•- ------- _Capacity-/.....'.11E...... Disposal Field: Distance from nearest well r Ga .Distance from foundation . Distance to nearest lot line Number of lines._a3_... Length of each line_._.. l9' Width of trench _�,- '' ___.__.._ Type of filter materiae Depth of filter material 1.� Total length- !'� � -- Seepage Pit: Distance to nearest we I __________________Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits---------------------Lining material__._ ____.._ -______-Size: Diameter-----------------------Depth................................. _ Cesspool: Distance from nearest well________________Distance from foundation_..-..__-•___,__-Lining material_ .________........................ E7Size: Diameter.. -------- ----- ---------Depth---•---•--------- ••-.--• , ........--•._L,iquid Capacity -- •••-•__.••••••-•_._._.gals. Privy: Distance from nearest well-----.--------------------------------------------Distance from nearest building........................................... ❑ Distance to nearest lot line-------------------------------------------- _•---- - ---,7----------------------------------- ------ •----= Remodeling and/or repairing (describe):--- ---- ----•-----------------------------------------------------------I... _.- -••--..................................... --------------------- ------------------- ------------- -- -------- -------- -----------------------•---• ---•---- --•____ ---•-••. --•-••. -•-•---• ------- _____--- •--- . -------- 1 hereby certify, that I have prepared this application and'-that the work will be done in accordance with San Joaquin County ordinances, StafeJ nd rules and re lat' s of the San Joaquin Local Health District.' (S' M° a _e - --------.-----------------------------------(Owner and/or Contractor) By----- ••-- -----•. --•----- ------- -•-•- . -------- ------ -•--•-•••....................(rifle).. -------• ----- •---- ----- (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--a1Z__--.:l..''- --- ----••--- --------- --------- REVIEWED.BY..........„_.. --- --.,..•. •--.•--• -------------•• - ---•---• ----•-- ••••--••---_ DATE....................................................... BUILDING PERMIT-ISSUW. w.-_ ............ ......................___ ________--- . -••- --•---•... . -----•--. DATE -•-•• •- ••--•-- --- -•- ................... Alterations and/or recommendations ------- ----- -•- -----.....-_. . -••••--- -=--•-- --•.••. ••-- -••-• •-•-- ---..--•• -------- ----=---••--••-____. FINAL INSPECTION BY-A4 ---------+a ______•-- -_---. Dnte 'S� �! 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 E5-9-2M Revised 8•'59 F.P.Co.