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APPLICATION FOR SANITATION PERMIT Permit No. ..��. ............ (Complete in Duplicate) Date Issued . �!-- tAl, 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 wit5 County Ordinance No. 549. ADDRESS AND LOCATION- - A�---------------d(�`_41&, „5 /' -----t -rl�lf_ '!"f', f ----•- JOB Owner's Name._.,..'._{42tv.d.-P.._.......94p6a------&Wj ---� --------- Phone------------------------------------ -----•---•--------------------------•-------------------------•---•. /4,p 'f`�- ---- ----- ------------------------------------------------- Phone----------------------------------- Contractor's Name______________ Installation will serve: Residence U3 r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _!-.___ Number of bedrooms___ Number of baths/;L Lot size _ _'0.410”-_---....•••--------------------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table __Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2- ardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes R�INo ❑ FHA/VA: Yes [r'lo ❑ 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___ _ ----Dista ncfrom foundation---J-~ Material ---------- No. of compartments_-_13-_---------- --Size a ------- .424lx ___`v Capaci s Disposal Field: Distance from nearest well.------ Distance from foundation.1P-__---___.Distance to nearest lot line...�_ .... [�'` Number of lines___...-_- _ ___ __ -____ ength of each line_____�� _�-___-___-_-Width of trench---. ______________________ Type of filter material_ , epth of filter material Total lengt -.�•-----------/--- /Q--------Distance to nearest lot line__-_...... Seepaagge it: Distance to nearestt well----- -------Distance fr m foundation___.. _. ____ �A L� Number of pits_____`_-'___- ______Lining material.. Size: Diameter__��_ Depth____��-------____________ 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------------------------------------------ 171 Distance to nearest lot line________________ _ --- --------------- Remodeling and/or repairing (destribe):---------- -----------------------------------------------------------------••---------------------------------•---------------- - ---- --------------------------•------------------------------------------------------ ---------------------------------------•----- ------•-----•-•----------------------------------- 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) k-40 --� - - ------------------(� Contractor) / J By:---------------------- - (rifle)--------- - ------------------------------------- ---------------------------------------- ----- (Plot - -- - (Plot plan, showing size of lot, location ys em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE...... ------------------------ APPLICATI.ON ACCEPTED BY------ -- ----------- :- .------------------------------ �' REVIEWE&BY-------------------------------------------- ----- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------- ------ DATE------------------------------------------------------------- Alterations and/or recommendations_--------------________�- -.---- _-- --- --- --•--------------------- --- ----__------ - ----------------- ---------- �. ;--------------------- '- -•--.. FINAL INSPECTION B yr- 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. ��