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APPLICATION FOR SANITATION PERMIT Permit No. ... __ l;! / (, (Complete in Duplicate) "4 This Permit Expires 1 Year From Date Issued Date Issued •_/l-_____1_.._� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANDel. CAT ON•-•-xyzy - , -•--, ------------------------------------------------------------------------------------------------------ Owner's Name-------- - ------------------------------------------------------------------------------------.-- Phone---------------------------- Address------------------- 3rL`. - Contractor's Name--------------------- - - ---10 --------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑,{Motel /❑ Other ❑ Number of living units: _`___ Number of bedrooms .Number of baths _/___ Lot size _ P '-4:re--_�___-_____•-_---_____ Water Supply: Public system Pellcommunity system ❑ Private ❑ Depth to Water Table 7r7vft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe P--nardpan ❑ Previous Application Made: Yes ❑ No P--*-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.) pticnk: Distance from nearest well_________________Distance from foundation-----------_--------Material______.______-__--_-_-_- _-___----.-.--___--_-_. No. of compartments--------------------------Size--------------------------- ...Liquid depth--------------------------Capacity----------------------- I os fiDistancfrom seld: Number of linesnearest, well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- P 1 -------------------------Length of each line------------------------------Width of french------------------------------------ Type of filter material--------------.----------Depth of filter material-----------------------Total length------------------------------------------ Seepage _--____-_-_____-:_-_-___-_------_---__-_Seepage Pit: Distance to nearest well--------- -- Distance f m fou da tion__x�c�.��__.Dist nce to nearest I t [�� Number of pits_-__f_____________Lining material- _,�/�__f�____.Size: Diameter-_-1 :•`.__..._Depth--0-&64--/---------------- Cesspool: epth__ __ 64--/_--_-___-___- 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--------------------------_---------------- V1 ❑ Distance to nearest lot line-------------------- ----------------- ----------------------------------------------------------------------------- r - - 1 Remodeling and/or repairing (describe)_______________ _ --------------------------------------------------------------•--------------------------------------------------------------•---------- --------------------- ------------------------ •-------------------------------- V" -------------------------------------------------------------•------•----•---------------------•--•---------•-------------------------------------------------------------------------•------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 gulations of the.San Joaquin Local Health District. (Signed)------------------------- ----- � - ------------ ---- --------------------------• (Orwa�+o4yor Contractor) BY: == - = ----- -----(rifle)---- ' -- (Plot plan, showing size of lot, location of system in rel to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- -- ---A ------------------------------------------------ DATE-------------- 0--W----1- REVIEWEDBY--------------------------------------------- - - — ------------------------------------------------ DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------��-' ------•--------------------------------------- DATE------------------------------------- ----------------------- Altrations and/or recommendations------------------------------------------------------------- ------------------------------------------------------------------------------------------------- -------------------------------------------------- Q- c ----------- - --------- -------------------------------------------------------------- -- --------- —�. Q' k ` ' �" '' �#.Ac. h �-0-� ------- ---------------------------------------- FINALINSPECTION 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 E5-92M REviScd 8-'59 F,P.Go,