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\j APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) L �rlcll This Permit Ex ires 1 Year From Date Issued Date Issued _____�/ _�-----Aion 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. f JOB ADDRESS AND LOCATION: VY---- - - .... f Owner's Name---------------- -------------------------- ----------------------- ---------- ------- -- Phone------------------------------------ Address--------------- -----------------------------------Address---------------4WAZI-- --------------------•- ------------------- Contractor's -----------------Contractor's Name _ --� ------- Y .:. ------lphone-----•-•--------------------------- Installation will serve: Residence [ Apartm nt I-louse ❑ -Commercial E] Trailer Court ❑ Motel [_1 Other E] Number of living units: __/-_ Number of bedrooms_- Number of baths _____ Lot size -- ------- ----------------_________ Water Supply: Public system R11_&mmunify system~❑' Private ❑ Depth to Water Tabled/,�ft. Character of soil to a depth of 3 feet: Sand ❑ .Gravel []. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E] No New Construction:, Yes [ lo ❑ FHA/VA: Yes ❑ No g3--' 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__:_/0---------Material_-_& - ---------- -, No. of compartments_.-_�� : Size_.r�- _' ---Liquid depth------- ''__�'_-_-Capacity____ p-_-_ a. Disposal Field: Distance from nearest well---- _-_=__-Distance from-foundatign-____ ........pistance to nearest to fline__r ----------- Number --fNumber of line5----,/--------- Length of each line4�---30___ 0_,2f2Width of trench.__.,�i-----------------_--_------ o Type of filter maferia/� � _.Depth-rof-fiifer_.material___1��`________-Total length_______. _ -`----------------- Seepage Pit: Distance to nearest well___-_:~'^ r--------Distance fr m foulndation-----1Q--------Distance to nearest lot line--- o� Number of pits_____,___------Lining material--- --Size: Diameter_-jv?_'_-----.---Depth -___-_____- 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__________________________________________ ❑ Distance to nearest lot line-- ------------------------------- ------------------------------------ Remodeling and/or repairing (describe):----------` - ' ---------------- -------- -- -- LL - T ----------------- .J- ------------------------------------------------------------------------- `_== ------------------------------ ----- iI hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County s ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ' Si ned T - I g )----------- ---- --- ------- ----- - -- -------------------------------------------------- -----•-------------- -- ----------------------------�6wner-..a�t�ontractor) Br----------------------------------------- �---- ----- ------ETi+le] , . (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 $Y------------ - -- --------------------------------------------------- DATE --------- ----- ,REVIEWED BY j f --------- -------------=------------------ DATE-- ----- -'-�-------------- ------ DATE$UILDING PERMIT iSSUEDy----- --- -- - ------------------ --- ----------- Alterations and/or recommendations---------- ---- --- --- -------------- - ------------------ -------------••-------------•------ ------------------------------•--- ------------- - -- -- -- ' ----------�` 1�t_-P.r� _------- f_f�_�. --.�-------------�`-�2----�------------------------------------ C _b� --------�t------------------ -- '-- 5 --f-- -------------------------------------- FINAL INSPECTION BY:--------- -- --------------------------------------------- Date I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wost Oak Street 'r .. i 1_ �_ A132 Sycamore Street J 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F,P.Ca.