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:. APPLICATION FOR SANITATION PERMIT Permit No. ....4_�.`{ _ �. ' (Complete in Duplicate) Date Issued ___! 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 Ordinance No. 549. F JOB ADDRESS AND LO ATION -!�--- � ?` G Owner's Name- --------2t - --------------------------------- Phone------------------------------------ ................................................................................ ----•------------------------------------------------------------•----•-----.. Contractor's Name �------ ---------------------------------------------------•----------------------- Phone..........................-------- Installation will serve: Residence ❑''Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: _/____ Number of bedrooms__ Number of b ths/. Lot size ---- _�C .._`__________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _4. ,_Z ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam a��Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 2----New Construction: Yes U--No ❑ FHA/VA: Yes o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Septic Ta k: Distance from nearest well...1�rtP------- Distance from foundation---le----------Material----0----- --=------------ No. of compartments------ -—-------------Size. _.__ Liquid depth----_4®1----________Capacity ! /dQ _.__ Disposal eId: Distance from nearest well_49_�_____Distance from foundation___`�___f.__.Distance to nearest lot line__`__.__. Number of lines-------,l_______�___- _ Length of each line---/,,_ ,�'____��.____._.Width of trench__. _-__/_,____________________ Type of filter,material._ epth of filter material----/9-----______Total length_____��_o._l........____________ f i Seepage Distance to nearest well_ f l____Distance fr m foundation_:,,��__________. s nce to nearest lot line___-______ Number of pits--- _._- g / _J _ p _._Lining rriatenaL____�� __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----------------------------------------_- ❑ Distance to nearest lot line-------------------------------------------------- ---------- ----_ -------------------------------------------------------- xe� �-- Remodeling and/or repairing (describe) '` `-�___- 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)---------------------------------- K --- r �r Contractor) By:------------------------------------------------ - ---1- ; - - -----(Title)----- ,1' - (Plot plan, showing size of lot, locatio f system in relation to wells, buildings, etc., call be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- 1 R'p`------------------------=------------------------ ---------------- DATE------ _—.-0�------------------------ REVIEWEDBY---------------------------------- -----------------=-•-------------------------------------------- ------- DATE------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------- ---------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendat'ons: ___________________________________________________________ ----------------------------------------- --- 'c' t- --- • --------------------------------------------- ------------------- ----------- ------ •-------- --->-- --------------------t ------A---------- ------------------------------------------------------------------ FINALINSPECT ON BY-. -- ------- ------------ -- Date-------------------------------------------------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street `I32 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co.