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APPLICATION FOR SANITATION PERMIT Permit No. ..../.. (Complete in Duplicate)4 This Permit Expires 1 Year From Date Issued Date Issued 10" Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein;deseribed. This application is made in compliance with County Ordinance No. 549 JOB ADDRESS AND L CATIO ....//.O -------- -- ---------------------------------I........ Owner's Name. ---- -- Phone............................... Address---------------------- ----------- --- ----------•--•- Contractor's Name-.. �ig . -------------------------------- Phone Installation will serve: idence ❑ Apartment House ° / ®�mmercial ❑ Trei��lre.r Court ❑ -. ❑ Other G Number of living units: ._(f� Number of bedrooms __ - Number of baths -_SP. Lot size Water Supply: Public system V05�ommunity system ❑ Private ❑ Depth to Water Tablet. Character of soil to"a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay loam ❑ Clay ❑. Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ,.,-macNew Construction: Yes ❑ No �FHA/VA: Yes []i� o R91— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation..._............. -_.Material--_-_---__--.-._-_._-..-__...-..---.------__... 7� No. of compartments ----•-Size----------------------------=---Liquid depth--------------------------Capacity----------- ------ Disposal Fi Id: Di ante f m near t well ------------ istance f om foun ation _.. .J* ...Dista a to earest lot line -�__. n X/ � Nu bar lines._. _. - _ _ _ gth of ach lin ----- - ; _.-. -- _Wid h of tr ch.-- ----_____-_---- �► Type ilte eria j D th o i er t rial_ __ - ------ To I I 9 --- - --- -- Seepage Pit: Distance to nearest ell_--_."7777'-_-___-Distance fr m foundation_.__- .. ° P-----.Di;t '' to nearest lot line_.-_ �-r_ [t]� Number of pits---- -_----___Lining material. --_ �r/ _.Size: Diameter-------- -- ---------Depth------_A Cesspool: Distance from nearest well-----------------Distance from foundation-------•------------Lining material------------------------------------- El Size: Diameter--------------------------------------Depth--------- ------------------------------------------Liquid Capacity--------------------- gals. Privy: Distance from nearest well---------------__-__-._--_.___--_--- --_--_-__Distance from nearest building \" ❑ to nearest lot line_______________________ 9 Remodeling and/or repairing (describe):-----•------------ - e ------------W,14 - -- -- ---------------------------------- •------•- ------•-----------------------------------------------------------------------------•----------------•-------•---------•--------------------------------------- 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, and rules an regulations of the San Joaquin Local Health District. (Signed). ------ By:----------- - Contractor) ----- ' c or) ----------------------------------------------- - - ---•-----•-----•--•-•----- - ---------------------Title----- � __ _ ( r -- (Plot plan, showing size of lot, location of sys+emfin, lation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ---------------- APPLICATION ACCEPTED BY________________________ DATE........ ._ _t -- ----------------------------------------------------------- ,,..{{ REVIEWED BY -------------•---------------- DATE `t - - -------------------------------- BUILDING PERMIT ISSUED........... --------- . •---------------•---•---------------------- ------ DATE Alterations and/or recommendations:--------------- -------------- --- - 0- ---------- '--- '- --_.- ----7.f. -. "c1--+ „_-.--+�•G�c-...l+L�___- ..:19--- --_-_----- _.-------------------............. ...... ........................................................................... 9f1 _-_------------------------- FINAL INSPECTION BY: -- -------- -- ----- ------ ---- ---------- Date-------- -------- -- - 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 F.P.Co.