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l s APPLICATION FOR SANITATION PERMIT Permit No. ••l.I L (Complete in Duplicate) �/ 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------------------L,6- --- ----------•-----•- l 'fll Owner's Name Name l + A09.1ty---- ---- Phone__- •------••••. •--_•---- Address1 } Contractor's Name--- ------00A.0 _ 90tOk- ' --------- ---------------------------------------------- Phone-----140 ....... ! Installation will serve: Residence , ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ __ Number of bedrooms --- _ Number of baths _ ----- Lot size -'i`i t ._.; _ ------------------------------ Water __.._-___.-_......... .....Water Supply: Public system ❑ Community system,tg Private ❑ Depth to Water Table .-. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ a Previous Application Made: Yes ❑ No New Construction Yes ] No ❑ FHA/VA: Yes % No ❑ 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 i' __Distance from foundation_----- -----------Material.. C -- -- ] No. of compartments__ : ._ ize._____ __ __ ':___Liquid depth-----'. ---------------Capacity____-- --------- Disposal __ --_-_Disposal Field: Distance from nearest well - __-.Distance from foundation 't 't._--_-_ Distance to nearest lot line 5* ] Number of lines_ ..... _-_Length of each line----- "5-1 Width of trench " ........................ Type of filter material.-__1 "£0_ - tk_Depth of filter material_.____-110____-Total length------1,. ___•____________________ p,d Seeypage Pit: Distance to nearest well' __.___._-_Distance from foundation . ' __..Distance to nearest lot line ��,� took, ! V l Humber of pits_________-_-__.Lining material______ -__ ____Size- Diameter____________ __.___Depth _____ ___-_._ __..._ Cesspool: Distance from nearest well--------------___Distance from foundation__:_--------------..Lining material_____._.____-._____..._..____________. F ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------_-_____________-_.-_--_._---- + ❑ Distance to nearest lot line----------------------------------------------------------------------------•---------'"----=---------------------------------------------- Remodeling and/or repairing (describe):-----------4 ...................................--------------------------------------•----------------- ---------------------•----------------------------- 3 -------------------------------- ------------------' - ------------------ •--------•'_ ------------------------------------------- - -------------------------------------------------------- ' 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, 4M (Signed) off* Rpt3.6 '� - -------- ----------------------------------- (Owner and or Contractor ) BY: -- .- -- ---- (Title) (Plot plan, showing size of lot, location o s tem in relation to wells, buildings, etc.,can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - --- - -- -------------------------------------------------- DATE---------3 = U------- ------ REVIEWEDBY--------------------------------------------- --- ------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---- ---------------------------------- DATE----------------------------------------------------------- Alterations and/or recommendations:----------- - ---------------------------------- ------------------------------------------------------------------------------------------------------------------------------=--------------------------------_--------_------------- --- ---- ----- ---------------- -- --------------------------------------------- f r -- --------------------- ----------- `- ------ ----------------------- - - ------------------------------ .L '- FINAL INSPECTION BY- , -- - -- --------- ----- -------------------••---- 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 a I ES-9-2M Revised 8-'59 F.P.Co.