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U z% U. ' Permit No.... �� j ,� APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) /'/ 0 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 ----------------- /.._I�-�-��'.� � a4x-------------a------ l---------------------------------�/��•� iG�oLe.4IC� /---------`-------- Owner's Name !>a__O�_�----- Phone__4/ ---f ------------------------------------------------ --- T f'p �i 1<-�__.-- A V CZ �' � 0 � IJ Address--------------------------------------------------------------------------------------------- •_.. Contractor's Name__�`'� r l �lr� `� S�-------------------------------- •---------------- Phona 1�fVK � Installation will serve: Residence 9 Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--_ Number of bedrooms -3 --- Number of baths __I---- Lot size ----- CA, 0-S_______________________________ i Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ 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 availa6le within.200 feet.) Ser4ic TDistance from nearest well------------- Distance from foundation ------------------- Material __.___-______._._-_-_.._____________-______.____. &joy No. of compartmen'------------------ ---Size -------------------------------- Liquid depth ------------------------- Capacity ----------------------- Disposal Field: Distance from nearest well.A4!!�O.._Distance from foundation ®.`._:----- Distance to nearest lot line --5-0-1 ... / „ pr d Type of filter material____. --�-. Length of each line -_--D-- Width of trench..__v_____...________.. Number of lines_---__=(_-__-.-------- - -i._----Depth of filter material-----L._�---`-_---Total length------------�+�-.----------•-____-- S a Pit: Di5fanAce fo nearest well__Pp _____Distance from foundation__�_p®- .___.Distance to nearest lot line ---- �� 1. R�V . f Numbe ._of pits ----- I---------------- Lining mate rial__9a�--------- Size: Diameter._.J-n3"..____ depth -----1;17__.T_ `_-------------- Cesspool Distance from nearest well_--: ------------- Distance from foundation ------------------ ..Lining material____________________________________ ❑ f.;g 1 Size: Diameter------------------------- ----------- Depth ------ ---------------------------------------------Liquid Capacity-.. ------------------------ ga Privy: �-' Distance from nearest well ------------------------_----_---.._Distance from nearest building ------.---------___---.---------.-___... i ❑ Distance to nearest lot line-- ---------------------------•---------------------- ---------------------------------------------------------- Remodeling and/or repairing (describe)------------ -------------------------- ------------------------------------_----- -- - - ------ - - --------------- -------------------••----------------------------------------------------•---- -- ---------------------•---•-------------------- -- -- --------------------------- ------ --------------- --------------------------- =__ ____.-______ _----- 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 Lo I Health District. ------- - ----- --- Contractor] Title BY:------------------------------------------------------------------------------------------------ ----------------- ------- (� )--------------- -' ------------------------ (Plot plan, showing size of lot, location of system in relation to w , buildings, etc., can be placed on reverse side). s FOR,DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .=�..-- w -- ------------------------------------------- ----•---- DATE------- = •-•---------•--------------- REVIEWEDBY --------------------- ----------------------------------------------------------------- -------------------------------------- DATE --------=-------------------------------------------- BUILDINGPERMIT ISSUED -------------------------------------------------------------- —-------------------------- ----------- DATE ------------------------------------------------------------- Alterations and/or recommendation :---------------------- - ------------------------------------------ - - _t----------------_.-.---------------- -..-------- ----------------------------------------------------- - . _ _ -> - -------------------------- - ----- ------------------- - - FINAL INSPECTION BY: -l--.------- 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 a Manteca, California Tracy, California ES -9-2M Revised 8-'59 F.P.Co.