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" APPLICATION FOR SANITATION PERMIT Permit No... ............ ® (Complete in Duplicate) L411 This Permit Expires 1 Year From Date Issued Date Issued __.._.0.1/Iia-:p 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 wiUhountyOrdinance No. 549. JOB ADDRESS AND LOCATION- -- Owner's Name /YL Phone__!�/p..2................ Address ...................... s �— _ / - �-----------------------•--------------•----------------------------- ------------------- Contractor's Name---------------------------- -- -�--�� ------ Phone ------------•---------------------- Installation will serve: Residence [�[, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Oily WVW4, Number of living units: 'Q Number of bedrooms -------- Number of baths -------- Lot size-___-___-___4O..ii'k----------- Water Supply: Public system Community 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 D4 No ❑ New Construction: Yes JR� No ❑ FHA/VA: Yes ❑ Nom TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is_available within 200 feet.) S tic�J�nk: Distance from nearest well__,Avd Distance from foundation._________________ -Material_________________--________..._..__.___.__... �%' No. of compartments---------- ------ Size -------------------------------- Liquid depth-------------------------Capacity-Z--° Disposal Field: Distance from nearest welIA/o' Distance from foundation.,lQ-._xE....Distance to nearest lot line -___L$7- Number of lines_____________ _ _ ___ Length of each line ........ 8__i�_._--------- Width of trench______p,7...________ - Type of filter material___. -__ _ _ _-Depth of filter material------ _ _..----- Total length --------- k70___________________ Seepage Pit: Distance to nearest well ---------------------- Distance from foundation__----__ ---•---___. Distance to nearest lot line ----------------- F1Number of pits---------------------- Lining material ----------------------- Sizer Diameter -----.--.--.----------- Dept h -----------------_--------------- 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 ---------- .___-_________-...________-_._. 0 ❑ Distance to nearest lot line---------------------------------------------------------------------- Remodeling and or repairing (describ ):______. plc/ov __._aPt'F!�//¢_ �_ ___. ii¢ ir��r�✓7� p ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, andles and regulations of the San Joaquin Local Health District. --------------------------------- (Signed)-, --=- •- -----------------------------------------------------------------------------------(Owner an /or Contractor By: ------------------------------------------------------------------------------------------------------------------------------------ (Title) ------------------------------------------------------ -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F911 D PAR MENT USE ONLY APPLICATION ACCEPTED BY------ ------- ---------------------------------------- DATE--- 31 ---- ---40- ----------- REVIEWEDBY ------------------------- --------------------------------------------------------------------------------------------------- DATE ------------------------------------------------------------ BUILDING PERMIT ISSUED -------------------------------------------------------------- ------------------------------_ -•---• DATE --------------------------- -- ---- Altejr,ations and/or recommendations------------------------------------------------------------- ------------------------------------------------------------------------------------------------- ------------------------------------------- --- - --•- .. - z yr ----- --- ------ -- -- --- --- -- . .... . _ --_-- -• ,- -- y --- -4- - U .r FINAL INSPECTION' -BY:. _,- . ' ---..................... Date.----- - ------Y. `J- 1 -- u 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 P.P.Co.