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APPLICATION FOR SANITATION PERMIT Permit No. ..fl- . (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Hate 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 Nor549 - ------•--------------------- _-----------------. JOB ADDRESS AND LOCATION------------- �EZ'�`-=------------------------------------------------- -- Owner's Name-------------- �C. � ' � ft'• - --------------- Phone------------•-------•----------•---- ------------------------------------------------------------------------------------------- Address---------------------- Contractor's Name--------f•---/ } v ' -----------------------------------------------------••----------------------- Phone-.-----.._----------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel.❑ Other ❑ Number of living units: ___ ___ Number of bedrooms Z Number of baths /_____ Lot sizd ------------------------ Water Supply: Public system ❑ Community system ❑ Private LjL, epth to Water Table,6,_,7ft. Character of soil to a depth of 3 feet: SZ��ZwConstruction: el-❑ Sandy Loam ❑ Clay Loa -'Clay ❑ Adobe ardpan Previous Application Made: Yes ❑ No Yes ❑ No HA/VA: Yes ❑ No d TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: jj -"Distance from nearest well_________________Distance from foundation--------------------Material__-_________.___________-._.-._______._._-___. i No. of compartments-------------- ----------Size---------------•--------•-------Liquid depth------------------------- Capacity----------------------- Distance Fi Distance from nearest well_ ' _-0_._Distance from foundation_ ___- ______Distance to nearest l�oU/t f�e_:57 _.____. Number of lines-__-____I________________________Length of each line___�1___-____________.Width of trench- .I-__ __.____-___-_--__ Type of filter material--_ G_4_r ____Depth of filter material—_--l— __ ______Total length.......... _________ Seepage Distance to nearest well_____ ______Distance from foundation__�---v___--------Distance to nearest lot line_____________ Number of pits-----I---------------Lining material_'. __? _-Size: Diameter----- ___-._.___Depth----_:�__-_ ------------ Cesspool: Distance from nearest well_________________Distance from foundation--_-----------------Lining material__-____________.____._.________._____-11 �\ Size: Diameter--------------------------------------Depth------------------------------ ---------------------Liquid Capacity-------------------- -------gals. \1 Privy: Distance from nearest well ------------------------------------------------Distance from nearest building---__--------------------------------- V ❑ Distance to nearest lot line------------------------ -----•-----------------------------•--------------------------------------------- ------------------------------ , Remodeling and/or repairing (describe):---------- c - . �- fi: -----•------ ��-E .: � --�----------------------- -----------------•-•-•----------------------------------------------------------------------------------------•-----------------------------------------------------------------------------------------r-------------------- --------------------------------- ----------------- ________________________________________________________________________________ _________________________________________________________________________________________________________________________________________ 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 ules and re ions of +he Joaquin Loca 77- ------------ By: n,District. * ` �_ s' C.L.--�, Li: ri_:t` 1- -- -------- caner and/or Contractor) (Signed) ----- -------- = `___� L " ---------(Title)--------- --------- - -�; —i �; (Plot plan, showing size of I , to a ion of stem in relation to wells, buildin e., can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----,T`h_Q----------------------i-------------------------------- -•-------------------- DATE-----/ - --------------------------- REVIEWEDBY------------------------------------ ------- ----------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------- ------------------------------------------------------------------------------------------- DATE---------------------------- -------------------------------- Alterations and/or recommendations: ----------------------------------------------- ----------••------------ ------------------- ----------------------------------------------- ----------- -----_-----______________-____.-.._._.___PI-d-_-.___.__PERT H___.------- _______________----______-____-_-__________________-__-._-______-___________._.______- --------------------- ---- --------------------------- ------------------------- ----------------------- -------- ---- --- ---- ----- --._.----------------------------------------------------------------------------_----------------------------.__ ___________________---------------__------------ .___ _-.- __ ----- --- ------- _ _ ----------------------------------------------------------------------------------------------- I t FINAL INSPECTION BY, __ __ _____ ________ __ _ _ Date. J� ------------------------ ------------ 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 ES-92M Revised 8-'59 f.P.Co.