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APPLICATION FOR SANITATION PERMIT Permit No. ....J_.. _ :->:.s� (Complete in Duplicate)A This Permit Expires 1 Year From Date Issued 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 ith County Ordinance . 549. J _ �j JOB ADDRESS AND LOCAT ov ----------------------------------------------------------------------- Owner's Name__.____ __. - ----- - - - ---------------------- Address_-------- Phonei _ - Contractor's Name__________________________ �`` - - - -------------------------------------------- - - --------•--...---- Phone----------------------- ------------ ! Installation will serve: Residence Uno"*Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/_ Number of bedrooms-- Number of baths L of size•,_ �__ �;, /, ��G', ..�----------------------------- Wa+er Supply: Public system ❑ Community system Private ❑ Depth to Water Table � Ft. 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 &9-<o ❑ FHA/VA:=Yes �N, o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well / e No. of compartments __ _ t Distance from oundation__.,f__•V-__-__. P Size- ��-Q Liquid depth *fp----------CapacitY• ---19------- Disposal Feld: Distance from nearest well.__:n-7........Distance from foundation---,�i ---------Distance to nearest lot line_---_...... Number of lines-----A__--_______________Length of each line___��_�--_ __.Width of trench.__.v`�iV_________-_-____-__--_-- Type of filter material_ Depth of filter;material_-__--- -T, length----Z40 ------------------- Seepage --------- -------Seepage Pit- Distance to nearest well___.___- Distance f om fou dation____ _ ---- ��_-._.._.Dist`�nce to nearest lot line c507 LAY Number of pits___/�_.____--___--_Lining material_ �/K,-Size: Diameter,_.__..____De th�s�_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.___-_-___--___._____________. ❑ Size: Diameter- -•: Liquid Capac De A --' --- - ---- �� itY----------------------------gals. :._ Privy: Distance from nearest well________________ _____________ _-_--:_._-___Distance from nearest building ❑ Distance to nearest lot line ---------- _` ---------------------------------------I--------------------------- ,,,��.� Remodeling and/or repairing (describe):-------- ----------------- '"<<:l/ �'_ ------------------------------ ------------------------------------------------------ ------------------------------•-----•------------------------•-----------------------------------------------------------------------------------•------------------------•--------------------- 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 reg ula+' ns of the San Joaquin Local Health District. (Signed). 4 -� �'_'_- ------------------- - or-------------------------------------------------- BY: .-�^ _ - (Title) :�? / (Plot plan, showing size of lot, location of s em in relation to wells, buildings,_etc., can be placed on reverse side). ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- - - --------- -----�---- -----'• .DATE----- - t - -- -- ------------------------- REVIEWED BY DATE-------------------- BUILDINGPERYIT ISSUED----------------------------------------------------------------------------------------------------- DATE A terations and/or recommendations:-.------------------------------------- ------------ ---------- - -------- --------------- -- FINAL INSPECTION BY ---- - 9— �o__. �� %r Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American`Street � +tr 30Q�West Oak Street 132'Sycamore Street, 814 North "C" Street Stock+on, California Lodi, California,i_t +. ± iii Manteca, California Tracy,it ES-9-2M Revised 8-'59 F.P.Co.