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�< APPLICATION FOR SANITATION PERMIT Permit No. ....f. G_ d 31, (Complete in Duplicate) (� This Permit Expires 1 Year From Date Issued bate 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. 141 6440A r JOB ADDRESS AND LOCATION ------- ---- --------�- Owner's Name--------__ _ - i hh --------------- Phone Address---.-.------ /•.!__ f� r �:/f�`-• /._(.��1 4 Contractor's Name------------- -- ------------------------------------------------------------ -•------ Phone-------------------------------- - Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/_- Number of bed rooms4, lumber of baths __f_ Lot size © _- , - - -------- Water Supply: Public system El Community system E] Private Depth to Water Table � 4. Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 2;1`� New Construction: Yes ❑ No FHA/VA: Yes ❑ No ®� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / *11 , Septic Tank: Distance from nearest well__ i�_-._ Distance f;pm foundation------14P------MatejiaIfl-� ---- I No. of compartments-----�-- ---------------Size4%--- ---- -----Liquid depth-_�V------------Capacity-.--�,�1��_.--- Disposal Field: Distance from nearest well_Ary-----Distance from foundation_10..........Distance to nearest l t line._ .01 __-_ I ®� Number of lines--------- Len th of each line--_-_ // g �(�!__��__.__ Width of trench_._ I - ------------------------ Type of filter maferiaL/ _ _ _ epth of filter material__- -----------Total length--------4i f Seepage Pit: Distance to nearest well___------------------Distance from foundation-_----- _-_.Distance to nearest lot line-_____------_-__ ❑ Number of pits----------------------Lining material---- _---_-_____.Size: Diameter-----------------------Depth-__-__--_-_----._--._-_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___----___--.._--_-_____---- ---------- El Size: Diameter--------------------------------------Depth----------------------------- ---------------------Liquid Capacity----•---------•-----------•-ga Privy: Distance from nearest well-____-._-____--------------------------------------------------------- from nearest building-.. l ❑ - ------------------------------------------ Distance to nearest lot iine - Remodeling and/or repairing (descri6e):---`-------"'W� -- ------------- -------------------------------------------------------------------------------- ------------•1-------------------------•---------------------------------------------------------------------------------•-------------------------------- -- --------------------------- " ------------------------------------------------------------------------------------- --------------------- - - I hereby certify that I have prepared this application and that the work will be doneNin accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin LocalHealth District. - Y. (Signed)__ -------------- - (E) orContractor) - ,- BY:-------------------•---------•----------••------ •-- --- - -- -----------=- - -------------{Title)- � --- - - •- - .. --- ------- (Plot plan, showing size of lot, location o stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------ DATE- — P7 ----------------------------------------- - REVIEWED BY . - .o ' -- - -- .----- - ------ DATE- ------------------ BUILDING PERMIT ISSUED----•---------------------- f _----------=---------' DATE-•------------ Alterations and/or recommendations: f i`-•-------� -----=-------------•----------------------------------=---------------- ------•------- ------------- -----------•---•----------------------------- •---- f] -------------------------------- --------------------------------- - ----------- - i e -•----•---------------------•---------- ----------•--------------------------------------------- 11 FINAL INSPECTION BY:--------------------------- ------ Date---------------------_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street - a 814 North "C" Street Stockton, California Lodi, California Manteca, California r Tracy, California ES-9-2M Revised 8-'59 F.P.Co.