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a �.- J APPLICATION FOR SANITATION PERMIT Permit No. ...�.....:Ql�..2. (Complete in Duplicate) A This Permit Expires 1 Year From Date Issued Date Issued ---rt�1. . 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. JOB ADDRESS AND LOCATION----1------ 3__Ji6_..!r"•-------.T_,;s- '��-A- 41d— R Owner's Name �-------- ----- Phone-----------------------•----•-- Address--------------------------------•--------------------------------------------------------------------- r` Contractor's Name D -___ Phone----_-----•-•--- ----------- Installation will serve: Residence ( Apartment House ❑- Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __ Number of bedroomsa__Z1Vumber of baths ___l___ Lot size ____a3_d__.X__l_7 ___________________ Water Supply: Publics stem Community system Private + Depth to Water Table __?_ ft. Y � � Y Y ❑ ❑ p Character of soil to a depth of 3 feed Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ I Previous Application Made: Yes ❑ No (L New Construction: Yes*] No ❑ FHA/VA: Yes ❑ No L' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool per'mitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------ Distance from foundation--- 4_-_ Materiai___ _ Ntee. ----. �] No, of compartments_______-__?rr_______Size____ _,e _, _ _, ___Liquid depth------- -_.________Capacity_____ ?_ _ -�-C Disposal Field: Distance from nearest well.___.-.......Distance from foundation____ ®______.Distance to nearest lot line____ (/_ r Number of lines:'i--------------/---------------Length of each line-------/-dp- - ------Width of french---------A-_.--------------------- Type of filter material___� Depth of filter material------ _'3-!-.___-Total length---------------- _-_'_-_--______ W { ion_1__' _v_�. Seepage Pit: Distance to nea're'st well____:._,.-__.___-_Distance from founclatDistance to nearest lot Number of pits----:_.____tl_____Lining material_-r_/!C..-Size: Diameter._3!_r_---- Dep th -2 r ' Cesspool: Distance from nearest well_________________Distance from foundation____,--------------------Lining material-------________-____-___________-____. ❑ Size: Diameter--------------------------------------Depth--------------------------------- ------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well___----------------------------------------------D?stance from nearest building------------------------------.--------- Distanceto nearest lot line--------------------------------------------------------------------------------------------------------------------- ---------------------- V' Remodeling a d/or re i6e):__________ -- O { ' - ------------------ ---- -------------------------- ----------------------------------- ........ -- p --- -------- ------------------------------------------------------ ---------------------------- r --------------------------------------------- I hereby certify that I have prepared this.,application and that+lie work will be done in accordance with San Joaquin County ordinances, State lags, and rules and'regulations'of the San Joaquin Local Health District. (Signed)------------------ /) &-t- ----------------------------------------------------- ----------------------------- ------(Owner and/or Contractor) { BY=---------------------------------------------------------------------------------=-------=---------------------------------------(Title)------- - -------- ---------------- -_------------- I (Plot plan, showing size of lot, location of-system in relation-to wells,•buildings, etc., can be placed on reverse side). t _ FOR EPARTMENT USE ONLY APPLICATION ACCEPTED BY----------I ----------------------------------------- DATE �� .�,C. G �`----- REVIEWEDBY---------------------------------- --------------------------------------------------------- DATE---------------------------------- ------------------------------------ BUILDING PERMIT ISSUED----- ---------I--------- --- ----- --------- ------ ------------ DATE ---- --------------------------------- - Alterations and/or recommendations: r R ------------ -- , _ s -------• +-•-----------------------------------------• ------ FINAL INSPECTI - ---- -------- ----- Date--------- I SAN JOAQUIN LOCAL HEALTH DISTRICT s 130 South American Street 300 West Oak Street 132 Sycamore Street 514 North "C" Street l Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.CD.