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r APPLICATION FOR SANITATION PERMIT Permit No. � ___l..�.........4_.� t �_ / C-`��U i� (Complete in Duplicate) ` This Permit Expires 1 Year From Date Issue ._9!_ Date Issued Application is hereby made to the San Joaquin Local Health District for a permit o nstruct and install the work herein described. This application is made in compliance with County Ordinance No. 549 (� JOB ADDRESS AND LOCATION--- ---------------------------------------- ----- --- ---------•------------------------------•-- Owner's Name ---- `'----- ------ ----------------------------------- Phone --------- .-------------------------- Address `---------- s ------ f ----- - ------------------------- - ; " 21a ( Contractors Name-------------- ------- ------------•--------------- Phone.._. r^ •-------- ----- Installation will serve: Residence Apartment House ❑ Commercial ❑ ''Trailer Court ❑ Motel ❑ Other ❑ r 1., i Number of living units: __/__ Number of bedrooms _o�-- Number of baths V.. Lot size _414X_I Z As ----- m --------------------- 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 -E] Clay ❑ ' Adobe Hardpan ❑ 1 Previous Application Made: Yes ❑ No New Construction: Yes ❑ No FHA%VA: Yes El No Z}— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool. permitted if public sewer is available within 200 feet.) , �, r•'°� Setic Tank:Distance from; nearest wel4----------------- Distance from foundation------------ --- ° Mat erial-----------------•_--.----__-___._.__--__-- No. of com artmenfs-------- _. ______.--Size--------___ Liquid depth '--------- Capacity Disposal Field: Distance from nearest we'll ------ Distance from foundation--- — ---------Distance to nearest lot li e-/LE%----- �' Number of lines---------- ------ __ -_ Length of each line ----- -' Width of trench---_�T_---------.---.-.------- Type of filter' material p • -- --De th of filter material ... Total length----- _r�_-•------------------------- Seepage Pit: Distance to nearest well-----:--- -' ----Distance from foundation_--.. JP--- -- DistprIce to nearest lot line-_ig (�_ Number of pits...... -_----___-_ Lining material---Diameter--,.??""-CK ..Size: .-_-Depth ..0!4.1 -_-1-------------_ 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]------------------ w4 -----------------------------------------------------------------•------------------------ ------------------------------------------------------ ••--------------------------------------------- -------- 1 I 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 rules and regulations of the San Joaquin Local Health District. Si ned ( 9 )----------------------------- --- - - '--------=- - -- -- - - - ------------------:- --.- ----{ r Contractor] --------------- ----------- -------........ ,efl By: ---(Title)---''---- ------------------- (Plot plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed on reverse side). i - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- - - �------------------ DATE ------ --- �.4-------------------------- REVIEWED BY ------------------------------ -------------------------`� -------------------- DATE--------------------------------------- -------- BUILDING PERMIT ISSUED Y -- --------_------------------ --------- DATE ------------------------------------------------- ----------- Alterationsand/or recommendations------- --- --- -------------------------...-----------_-------------------------.-.-..----------------------- -------------------------------------------- --------------------------- I------------------------------------------------------------ I ---- ---------------------------------------------- •------------------------------------------------------------------------- ------------------------------------------------------------------ ---------------------------------------------------------------------------•------------------------------------------------- --------------------- FINAL INSPECTION BY:---±--------- --------- - -- I �-- ' ----------------------- bate SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street ; - a 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Es -9-2M Revised 8-'59 F.P_Co.