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APPLICATION ION FOR SANITATION PERMIT Permit No. .. _�... I , (Complete in Duplicate) / This Permit Expires i Year From Date Issued Date Issued ...... -- -! Application lis hereby made to the San Health Joaquin Local Hea q h Di strict for a permit to construe} and install the work herein described. This application is made in compliance with County Ordinance No r49. JOB ADDRESS ANI N LOCATI 13-3-d---- g_ Owner's Name -``-- Phone r Address.......11.0 ---------------------------------------------------------------------- Contractor's Name------------------ ----- -.e--- ------- - -------------------------- ------ Phon .e/ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer��C,}oo�uurt IJ Motel El Other �- Number of living units: -- ----- Number of bedrooms ________ Number of baths gtoci f"size -------- ------------------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 6`0_ ft. Character of soil to a depth of 3 feet:< Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er`H'ardpan ❑ Previous Application Made: Yes ❑ No 91----New Construction: Yes P?IN'. ❑ FHA/VA: Yes ❑ 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/o&--.__----Distance from foundation------`��______.Material___(�� _- --------- �� Noof compartments-------._________-_r____Size-57F Liquid depth__ �.7----- --------Capacity.../S4 ------ Disposal ---- Disposal Field: Distance from nearest well/40-----------Distance from foundation-_�4Q-_1----Distance to nearest lot line...... C" Number of lines---------a---------------= Length-of-each line___�d�__�-��-------Width of french-------�5/. �--------------- . r�AAyy 'g Vv Type of filter material___5_f________________Depth of filter material___L __.___f____To#al length__________-k __._:___________________ Seepage Pit: Distance to nearest weIIrDQ!--_f___Distance�m foundation___(Pa-_______Distance to nearest lot line____-5--�____.- D Number of pits-------9.----------Lining material__ _ _��----Size: Diameter__,Fj�------------Depth-------R _ t -- -- --------------- Cesspool: Distance from nearest well----------_------Distance from foundation__------------.-----Lining material-__________.__._______-__ --- ❑ 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 ,.. - ---•-- -----------•--------------------`--- ----------------------------- , - --- -- ------------- ------------------------ --------------- -- ---- - :_ - - _ T ., i ! .... *, .,... ' '---------------------------------------- ------------------------------•---•--------------------------------------------------------------------- - =. I hereb ify that I have prepared this application and that the work will be done in accordance with San Joaquin County y} ordinance , S ate aws,:and rules and regulations of the San Joaquin Local Health District. (Signed)--- f -------------------- -` 4-------- ------------------------------------------ i(Owner and/or Contract By:-------------------- ..--------- -- ----- - - ----------------:---------------------------------------- Title (Plot plan, showing size of lot, location of sy in relation to wells, buildings, etc., can be placed on reverse..side). r FOR DEPARTMENT USE ONLY / ) APPLICATION ACCEPTED REVIEWED BY------------------------------- ------------- ---- ------ DATE------------- = I ----------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATES Alterations and/or recommendations--------------------.---------------------- -----------------_____________________ �_____________________ ____ __-- _ __. ---------------- ------------- --p_______________ ____ _______ _ _ _ - � ---- ---- `t------- -------------------------- FINAL INSPECTION BY ..... 3 - Y p - --- �� `�L�?t/�t� Date----,/.-. �/ • ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D 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. l