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APPLICATION FOR SANITATION PERMIT Permit No-__1...�_7. (Complete in Duplicate) � This Permit Expires 1 Year From Date Issued bate Issued -.` l/- __j-.,6 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 compliant ��yrit u Q mance o. 549. R JOB ADDRESS AND LOCATION_ -- Owner's Name Phone. Address �. ------- -------- • - - --Y-----------• `✓ -------••- Contractor's Name_ ---------------- ....... -� � �_ ��-•- -- - Phone-_ Installation will serve: Residence.'Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ kNumber of living units: __2�lumber of bedrooms --YNumber of baths _-Yet size ----Z. ' t � Supply: Public system xCommunity system ❑ Private ❑ Depth to Water Table �0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam [: Clay [] Adobe EO Hardpan ❑ Previous Application Made: Yes ❑ 'No�" New Construction: Yes ❑ No FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ""'"' (No septic tank or!cesspool permitted if public sewer is available within 200 feet.) . I Septic Tank: Distance from nearest well tiU��Distance from foundation__✓!_P.�--_____.Material_-__ --- --- - r �f 9 - �— No. of compartments.------rye ----------Sized - --�fi�--------Liquid depth---- -Q`�----------Capacity_ _y o---- Dispose! Field: Distance from nearest well._r\ohj_Distance trorn foundation,-.!- Distance to nearest lot line___-- f Number of lines__�c _ Len th of each -_�-� fi Length - �Q_.Width of trench-------`-'-�-`�---�-- ------- --- Type of filter material- i'c (�_._.Depth of filter material---I _!_�_-_______Total length--------- _ :�1_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 ❑ Size: Marnefer--- Depth_- --------Liquid Capacity--------- gals. �n V. Privy: Distance from nearest well-----------------------------------------------1 --Distance from nearest building -------------------------------- ❑ Distance to nearest lot line----- Remodeling and/or repairing (describe):--- / _1„r, - •- --- , ` ' ---------------------- ----------------------------------=------------------ --- _________________________________________4--_______________-____-_________ _________________________________ I hereby certify that I have prepared this application and that the work will be done in accordance with Sarf Joaquin County ordinances, State laws, d rules and regulations of the-San Joaquin Local Health District. (Signed)_ i ' - i#Janes ------------------------------------ ---o-- --- -- Contractor)------------ --------- -- --- --- BY PTIC r K S�RVCE --- f -----fl------ Title--------------------- -- ---------•--- ----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- DATE__---_.___ ._ ---- ---------------------------------- -------- IEWEDBY ----------------------------- ------ --- ------- - BUILDING PERMIT ISSUED_ ---- ------- --------- •- - ----------- -- DATE---------------------------- -------------------------------- -- ----------------- - -- - -----------------------— ------------------------- DATE - ------------------------- ,Al terations and/or recommendations:________.-___ / ---.-__._ - _ --I - . . - � -� --- -•--- -- ------------ ------- - �" �t— FINAL INSPECTION BY:.. Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street .300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Es-9-2M Revised 8-'59 r.P.CD.