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4] � APPLICATION FOR SANITATION PERMIT Permit No. ._.�C.. .. . (Complete in Duplicate) This Permit Expires I Year From Date Issued Date Issued .__.. l!_ --�-G 4-2...1 0 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 with County Ordinance No. 549. JOB ADDRESS AND LOCAT ON._..-- 44Zav _ ••-•--- ________________••_•__-_---_........_._.._.....---------•-•_•_---___----__•__-_-•_-__•_ Owner's Name------ _._ ------------------------------------------------------------------------------------ Phone.................................... & -- ..---------•--....... :------------------------------------------------------------------------------------------------------------------ I rN Contractor's Name Phone------------•---•----•--------;•--- Installation will serve: Residence [W Apartment House ❑ Commercial ❑ Trailer Court ❑ff Motel [I Other __f 1- Number of living units: __f__ Number of bedrooms S. Number of baths .. Lot size -_.1 .................................... mmunity system ❑ Private E] Depth to Water Table /f t. Water Supply: Public system [Co 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 &j/'FHA/VA: Yes ❑ No [�j— 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___--_-______--_-__-.__.,.--_____--_-----._-___-. K IS 0/ f No. of compartments-----------,------_-__,.Size--------------------------------Li uid de th__________________________Capacity-------------- �;•--- Disposa Field: Distance from nearest well "'__Distance from foundation....1� ._._-----Distance to nearest lot line.__..... -�_ - -____Length each line____ .__ �Z Number of lines___ y/r._:_._.___.Width of trench_.___i2'1l Type of filter materiapylDepth of filter material____ l1..............Total length--------- .. Seepage Pit: Distance to nearest well---------------------- from foundation....................Distance to nearest lot line_--__-_--__--__-- w ❑ Number of pits--_.- .____.-__-__Lining material--------------------- Diameter-----------------------Depth---------.-.___-_____________-__. (�fl Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 0 Size: Diameter------- ------Depth--------------------------------------••----------Liquid Capacity-------------- -------------gals. Privy: Distance from nearest well-------.-----------------------------------------Distance from nearest building_____-_____._--__-_______.___-__--_-_-_. ❑ Distance to nearest lot line------------------------------- --------------------- -•---------------------•--------------- -----_---- ----- q�- Remodeling an or re airing escri e) � 4 / . ----------------------------- ------------------------•----------------------------------------------------------------------------------------------------•---------------------------------------------------••------- 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 regulations of the San Joaquin Local Health District. (Signed) - (Oimm�or Contractor) �' Title-------- - ---- -- (Plot plan, showing size of lot, location of system n elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- f - --- - ---- ----- - -------------- DATE ---� = REVIEWEDBY--------------------------------------oe------- ---- --- ---- -- ------------------------------------ DATE.---------------------------------------------------------- BUILDING ----------------------------- --- --=--•- ------BUILDING PERMIT ISSUED----------------------------•---------------------------------------------------- ------------------ DATE---------------- ---------------------------------------- Alterations ------ ---------------- ------Alterations and/or recommendations---------- --- ---------- ------------------------------------------------------------------------------- -------------------- ------------ ------------------------------------ ------------ -- •----------- ------....__.....----------------------------- ---- -----------------------------------------------------------------------------------............----=-------------------------------------------------------............................ t ---- -' ----- ---FINAL INSPECTION B: ------ ( ---- ,ZiDate SAN-JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wait Oak Street; 132--Syc4more Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 P.P.Co.