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APPLICATION FOR SANITATION PERMIT Permit No....�1..� I .(Complete in Duplicate) Date Issued ._... l ------------ Application �..-_ 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. IX 7S-1/ JOB ADDRESS AND LOCATION ------------- 1.0t,_0 -----&&-------------------- - - - ---f - -------..--.----- Owner's Name�#_ i d<t; :e _--- *_ .I(: ---------- Phone ---------_------- ----•----- Address---------•- •-•9v .----••----------------------------------------------------------------------------------------- Contractor's Name---- -_. _ e--_ 0,01 -T— _$Awt*._ 01- ------------------------------------------------------------,1 Phone---------'-,W,�_ Installation will serve: Residence Ej Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-: --- Number of bedrooms ----- Number of baths .I ----- Lot size 4___ -__126-0----------------------------- Water Supply: Public system ❑ Community system l Private ❑ Depth .to Water Table _4-6- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 14 Hardpan ❑ Previous Application Made: Yes ❑ No M New Construction: YeX❑ VNo ❑ FHA/VA: Yes K 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 `------- Distance from foundation --.. _.Material_ '? No. of compartments___ _ _ ._ Size___... _ __ A'_____ Liquid depth `'------------------ Capacity....'0-_ Disposal Field: Distance from nearest well _-Distance from foundation .......Distance to nearest lot line ........ .-.I Number of lines_ ___ __ _--- Length of each line -------- 7!�* _ _ Width of trench-_ _ -._.. Type of filter material-_-_ X'V_0jakDepth of filter material -------- 1-8a* ------ Total length-- _ ----------------------------- Seepage Seepage Pit: Distance to nearest well_ ---------- Distance from foundation ------- .Distance to nearest lot line ❑ Number of pits .._____-__ -_ _ _ Lining material-_-_ PO— ------- Diameter-__ ...________Depth *AX!R ----------- Cesspool: --_-_ ---.Cesspool: Distance from nearest well ----------------- Distance from foundation._ ---- ------------ Lining material _---._____----___--.-----__-_-_-_. i ❑ Size: Diameter------------ ------------ ----------- Depth ---------------- •------ ----- -------------Liquid Capacity---------------------- -----gals. �s Privy: Distance from nearest well --- _-------------------- _------------------------ Distance from nearest building ------ .------ _______-_-..._.___.__.____--- ❑ Distance to nearest lot line ---------------------------------- ------------------------------------ ---------------------------------------------------------------------- +' _ Remodeling and/or repairing (describe):------------------ ------------------------------ I ------____ ___ ________ --------------------------- ---------------------------------------------------------------------------------------------=---------------------------------------------- ---------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -- - - - - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 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)___ _ .. ___ _______ �tP y __ _.-----------------------------------------(Owner and/or Contractor) By:-------------------- ------------------- ---- = -- ---- ----- ----(Title)----f ? AOV-- ------------- - ---- -------- (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------ -�----------------------------------------------------- DATE-----------•- ` ." _ (a - -------- REVIEWEDBY ------------------------------------------------------------------------------- -------------------- - . DATE ------------------------------------------------------------ BUILDINGPERMIT ISSUED ......... ----------------------------------------------------------------------------•-•------------ DATE ------------------------------------------------------ ------ Alterations and/or recommendations------------------------------------------------ --------------------------------------------------------------------- -------------- ---------------------- - ------------------------------- - - - - - --- - �----- ,� ------ _ ------------ - ---- �-2-------------------------------------- = -- - - ------ - r FINAL INSPECTION BY --------------------- Date- aro - ------------------------------ R SAN JOAQUIN LOCAL HEALTH DISTRICT. 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M 'Revised 8-'59 F.P.Co. fl