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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate)� Date Issued ____ 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 m de in compliance with County Ordinance No. 549. :,9.Y0A.7 00PI$ ' --------------------- ---------------- JOB ADDRESS AND LOCATION_-O€air----443J 0.49- Owner's Name----------X(a ---------- Phone ------------------------------------ Address___... T --------- Zo -------------------------------------------------------------------------------- Contractor's Name_______________j •• - ------------------- ---- Phone.�r��J___.. Installation will serve: Residence 0 Apartment House Commercial E] Trailer Court ❑ Motel El Other ❑ Number of living units:.___ Number of bedrooms _,3-__ Number of baths _-$-- Lot size --- IVO --X- -,,24-9-------------------= Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table --- ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy loam ❑ Clay Loam El Clay E] Adobe E] Hardpan ❑: Previous Application Made: Yes El No New Construction: Yes ElNo/(T FHA/VA: Yes El No4" TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted -if --public sewer is available within 200.feet.) Peo Distance from nearest well________________ Distance from foundation --------------------- Material ------------------------------------------------ . No. of compartments------------- '----------- Size ---------------------------------Liquid depth -------------------------- Capacity ---------- ------- ---• is Id: Distance from nearest well. _.--__-Distance from foundation. --,/,(ii--- ------Distance to nearest lot line __----- Number of lines________ ------------ Length of each line_____ _-_;__.__. -- Width of trench_____ __ { 7� Type of filter mate ---Depth of filter material ------ ......... Total length___,eeP!--- ____------------------ __ i + Distance from foundation -------- _----------- Distance to nearest lot line -------------- Seepage Pit: Distance to nearest well ---------------------- l ❑ Number of pits ---------------------- Lining material ----------------------- Size: Diameter----------------------- Depth --------------------- -: --C , Cesspool: Distance from nearest well ----------------- Distance from foundation _--------------- --_Lining material ------------------------------------ ,._ 1.4 El.. Size: Diameter------------ --------------- ----Depth------------------------ ---------- - -------------- Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building ----------------------------------------- h ❑ Distance to nearest lot line--------------- ---------- ------------------------ ----------------------,--------•-----------------:- ` ------ ------ ----- Remodeling and/or repairing (describe):_-_ -.. - ------------- /0- - - -- - --------------------------' =.. -------•-----•------------------------------- r�--------------- ----- -- ----�3------------- ----------------------------------•------------------------------- -------- -- ! 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 r s and regulatio a San Joaquin Local Health District. (Signed} -----�----------- wner and/or Contractor) ----- Title ------- By:y._ (Plot plan, showing size of lot, location of stem in relation to wells, b I ngs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------- ..-- ------- -- -------- REVIEWED BY---------------------------- ------ ----------------- - ------------------------- BUILDINGPERMIT ISSUED -------------------------------------------------------------- ------------------------------ --- Alterations and/or recommendations-------------------------------------------------------------------------------- DATE---------- v --------------- DATE--------------------------- DATE ----------------------------------------- ----------- -- DA•TE----------------------------------------- - -------------------------------------------------------------- ----- -------------- -j ----- --------------------------------- 11NAL INSPECTION BY:. --------------------- Date. r 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 -9-2M Revised 8-'59 F.P.Co.