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APPLICATION FOR SANITATION PERMIT Permit No. J.1 ...'.:.. t (Complete in Duplicate) Date Issued i 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 install the work herein described. This application is made in compliance with County Ordinbnce No. 549. JOB ADDRESS N CATION--------------31 ree ......------------------•••••--••••----------------••-••-------••-......�% ` Owner's Name / _ ---------- Phone.. -- -- - ---• ----- ---/-------•------------ Address •• ..... ... .. . ----- ------------- ••.•---• •.......•-----------------------------------------------•----......_---••--•---------••-----. Contractor's Name-------- L - •- ---------------------- -------------- ---------------------------------------------- Phone................................... Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: _ ___-_ Number of bedrooms umber of baths __l___ Lot size ------0- -------K--14 -- - ------ --------------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 30 ft. Character of soil to a depth-of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E!f— Hardpan ❑ Previous Application Made: Yes ❑ No JRL New Construction: Yes 9 No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: f� (No septic tank or cesspool permitted if public s*er is available within 200 feet.) / Septic Tank: Distance from nearest well Z7_G'----Distan from fou�ndation-_/ --------Mat i I-- � --- - - -- -------------- No. of compartments___ __;y ::_Size-X��`�-.___..._Liquid depfh ___Capacity-_- ------- --------- ---- Dispos I Field: Distance from neatest eIL__� _�_Distance from foundation. ________Distance to nearest lot line._ _ ........ Number of lines_._._ _ ff _ ________ ngth of each line______. l(�Vidth of trench_____ _______ Ilk- Type { of filter materiale-__ __ ?i'�epth of filter material Total length &--- ---------------- Seepage Pit: Distance to.nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- 171 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well--------------- from foundation_..----------------Lining material_-.___-______-___-_______-__-_._._ ❑ Size: Diameter----------------------=---------------Depth---------------------------------------------------_Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______--________-___-___-_______-_____.... ❑ Distance to nearest loft 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 laws, and rules and r gulations of the San Joaquin Local Health District. (Signed) / ��' ��n O and/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). OR DEPA TMENT USE ONLY FF APPLICATIONACCEPTED BY----------- --- -- - -- ------------------------------------------- DATE............•----•------. .. ------------------- REVIEWED BY----------------------------------- ------------------------------------------------------------------------------------ DATE...... ...... ---(-� ---------------------------------------- BUILDINGPERMIT ISSUED----------------- .......---------------t--------------------------------------------------- DATE------- -••-------- ---------------------------------- Alterationsand/or recommendations------------------- -----------------------------------------------------------------•-------------------------------------------••---...........--.....-- --------------------------------------------------------------------------- ------------------ -----------W---------------------------------------------------------------...-------------------------•--------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------•-------- -----------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------ ----- FINAL INSPECTION BY:--------- '� `_`? Date r� -- -- - - --- --------------------------------------- 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.