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APPLICATION FOR SANITATION PERMIT Permit No. ._..._____ (Complete in Duplicate) ' Date Issued . �/��5� Application is hereby made to the Sarn`Joaquin Local Health District for a per it to con true and install the work herein described. This_applrcation is made-in-compliantegwi+h Co my Ordinance No. 549. �� ` �pS'oYk ext c s .r , s JbB'ADD RESS-M 'L CAT O Owner's Name__ Address------- -- --_ __-- j -------------- .. ------ Phone------------ w -------------------------- Contractor's - • ---- Contractor s Name- -------------------------------------------------- ____________________-------=-•-------------------- . { P ------------------------------ ------ Phone------- Installation will serve: - Residence --•-------- [ A artment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units: +Number of bedrooms ❑, Other ❑ > _ Number of baths Lot size �/ Supply: Publics stem T ��' � ------------ Water ------------•-------- Y ❑ Community system Private ❑ Depth to Water Table t7 1} Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam-E] Clay ❑ Adobe lard an Previous Application Made: Yes � No ,�� ' p ❑ L"7 New Construction: Yes ��o ❑ FHA/VA: Yes �o ❑ TYPE OF INSTALLATION AND SRECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from near - p LL M _ from foundation___-__ - Ma#er'al__ _ �r No. of com artmen}st we!!____"__.___".::Distance/ � F p -----.---- --Sizez�l�-_ __ ,e.�ry -f -.Liquid depth= , Disposal Field: Distance from neare4 well____.'__- f Capacity__ " p� F F - ._.Distance from foundatiQn___��- ___--"".Distance to nearest lat line__ _ _ � Number of fines______-, r Length of each line Type of filter material_ }}�� V� Width of trench.__ ! =-- f��Y_Depth of filter material__ �� 1 ' ' 1, -- ---- . (Total length.__._ ------ Seepage Pit: Distance to nearest well----_�7"" Distance from fou` ation__.. ____-_-.prance to nearest lot line_ 0_"�__ " N:imber of pits-_' ` -" 1 "_.. _,___Lining materral��.___.-- - :Size: Diameter_ r� r ----..Depth-----A-P------------------ lT� Cesspool: Distance from nearest well---- ------ Distance from foundation_____________ ❑ Size: Diameter. = Depth Lining material 9 a ---------- -----Liquid Capacity-- ---------_ - alsl` Privy: Distance from nearest well________________________-------------------- __ " ---------------- F._ from nearest building------------------------ ❑ Distance to nearest`lot line__._____-x_____ " ------------ - - ---------------------------------- ' and/or-repairing (describe ------- -------------------- --- s -------------- ----------------------------------------------------------------------- Remodeling --- _ -•--------- ---- ------------------ ------------------- - -------•-- --------------------------•--------•-------------------------------------- --------------------------- ~ ordinances, State laws, and rules -=------ ---------------------------------------------------------------------------------------------------- --------•----------------------- i I hereby certify that I`have prepared this application and that the work will be done in accordance with San Joaquin County and regulations of the San Joaquin Local Health District. F (Signed) =----- -------- L � By:_-------------------------••--Aa ,o �i1/ ract (Title)--,- , _ on or. (Plot plan, showing size of lotof system in relation to wells, buildings, etc.,can be placed on reverse ide), ------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ _ REVIEWED $Y___________________ -------------------------- DATE-----Z--- - ` - _ d -------- ------- DATE------------•--/------- BUILDING PERMIT ISSUED-------•------------------------- ---- ----------------------------------- Alterations and/or recommendations:._.___,-__•-------"__-.- DAT1=____-__-- - - ------------------------------------------ ----------- ----------------- ----•-- ---------- ---------- - .n_a.!_7"_..__ . _ _-- m.,C ---•---------------------•--------- ----- ------------------------- ---------- ----------------------- FINAL INSPECTION BY:--------_ _ Date. — 5 .7-------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street w A;30d West Oak Street Stockton, California y 132 Sycamore Street 1 814 North "C" Streef Lodi, California Manteca, California 7raey, California ES-9--2M Revised 1-57 ERCO.