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APPLIOATION FOR SANITATION PERMIT Permit No. ..1.. � ... V\" �� , (Complete in Duplicate) Date Issued .... / •L� ' This Permit Expires 1 Year From Date Issued Application is here y made to the SaftJin cal ealth District for a permit to construct and install the work herein described. This application is made in compliancerdinance No. 549.--- � / G ---- ---- --•---•------•---- JOB ADDRESS AND OC ION______ ..---------....................-....................... L Owner's Name.-•----- � 2i......... Phone - ------------------------ - Contractor's Name.---_ ----------------------------------------------- Phone-,/? Installation will serve: Residence []••''Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .__ Number of bedrooms __ Number of baths _� Lot size ---------- Water Supply: Public system ❑ Community system ❑ -Private EY-lbepth to Water Table 4.10 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E--Hardpan ❑ Previous Application Made: Yes ❑ No [TT"_'New Construction: Yes o ❑ FHA/VA: Yes ❑ No ❑ TYPE %F INSTALLATION AND SPECIFICATIONS: (Na septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic T nk: Distance from nearest well.•__�._�_....__ Distance from foundation--.,l M teri I Q ---------------- No. of com artments.._ -.-___Size.-�P•�__-.M Liquid de th_-_� Ca acit �C2-X1-,0_ Disposal Field: Distance from nearest e11- �___._..__Distance from foundation_, .........Distance to nearest lot line:�......_.__. Number of lines___.___.._._.__ Len th of each line--/--W__- .,�___.Width of trench_______ .__ Type of filter material._ c __Depth of filter material--,&_____________Total length------- ---___-__._.__---__-_ 06 See a e it: Distance to nearest well. ' _(___..__Distance m f undation___ _.�.�.__.. is an to nearest lot line._S p g Number of pits___-�-_-__-_____Lining material__ , '_..Size: Diameter--- ----------Depth----._ -R,_5... ------- d Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material_.___________----_----__--_--__-_-_-_. ❑ p ----------------------------------------------------Liquid Capacity----------------------------gals. Size: Diameter--------------------------------------De th----------------------------------- Privy: Distance from nearest well.------------------------_-----------------------Distance from nearest building--_______.___.-_-__-__•__--____-___-_____. ❑ Distance to nearest lot line------------------------------------------------------------••----------•-------------•-----------•----------------------------------------- Remodeling and/or repairing (describe):-----------------------------------------------------------------------------------•------------------------------------------------------------------- --------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I here certify t at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance , Stat la , and rule and regu ions of the San Joaquin Local Health District. caner and/or Contractor (Signed)------------ ----------- L ---- ----- ----- ----- ------ ----- ------------` -- ( / ) BY: (rtle) a�_-r--- (Plot ---------- .. --- --------- plan, showing size of lot, location of system in ration to wells, bui din s etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- b DATE - ----------------------------------- REVIEWED BY-----------------------------------•--- 'f DATE BUILDING PERMIT ISSUED---------------------------------------------------------------•..................................... DATE----------------------------------------------------------- Alterations and/or recommendations----------------------------------------------------------------------------------------------------------------------•------•--------.........-•-•_..------- - ._-- ---- --------------- ;�""------- ,,l ----- _/ ; yJZ. Z .J.- -- -- ;i "�}--=--•-t —c :e: 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.