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$` APPLICATION FOR SANITATION PERMIT Permit No...f...... .. (Complete in Duplicate) � . This Permit Expires 'I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Heal}h District for a permit to construct and -install the work herein described. This application is made in complianc fit u inance o. 549. . '----- JOB ADDRESS AND LOCATION-----' ------ -------- ---- Owner's Name-- � � ------ -- _ Phone Address -- ---7---d-;- c -- /1-A--------- Phone Contractor's Name. J---- --_-.-- _ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ umber of bedrooms __��Iumber of baths -_71-"Lot size ----/-9 . ----_--X------- ___ ________ 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 ❑ Clay ❑ Adob ( Hardpan ❑ Previous Application Made: Yes ❑ No� New Construction: Yes ❑ No [HA/VA: Yes ❑ N>.1,�� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distance from foundation__(_n _ � ! --- ------ -Material---------- ------ ------ ------- -�--�_--- No, of compartments_.____.) ______ �� --4---- q d p. " capacity---Size-•- �- Li ui de th___J9--p- ---------Ca acit .7-00-- Qispasal Field: Distance from nearest well.. �s2Y�4_Distance {rom foundation___/_.p_____.Distance to nearest lot line___-_ ______�_ -49 Number of lines____c13-------.______ _ _ Length of each line__�p� �. ._;4.`Width of french-------- `!_______________ "jam Type of filter material- I' ._.__Depth of filter material _�f_________Total length--------- est well____________________Distance from foundation____________....___.Distance to nearest lot line_____.______.__.. Seepage Pit: Distance to near ❑ Number of pits-- '-----------------Lining material.----------------------Size: Diameter------------------..___.Depth-------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material__.___-_________________.________- ❑ Size: Diameter------------------ -- ----------------Depth--------------------- -----------------------------Liquid Capacity----------------------------gals. _ Privy: Distance from nearest wel _____________________�-___________.___ _-_.' l _ __Distance from nearest building--------------------------------------- __ ❑ Distance to nearest lot line----------------------------- ---------------------------------------•--------------------------------------------------------------------.-. Remodeling and/or repairing (describe):___ % .______ _ _ _ ____ --..-_---_-_-------t�.... -- ---�--__�"-�p-`- ------ ---- ---------------------------- ----------------- -----------------------, 1 ------ --------f�-- ------------------------------------------------- ----------------------------------------------------•--------------------------------------------------------------------------------------------------- c I hereby certify that I have prepared this application and that the work will be done in accordance with SaK Joaquin County ordinances, State laws1d rules and regulations of the,San Joaquin Local Health District. (Signed)----------' may �T �fV i [,� f CCy�s r Contractor) n P71C 'TANK SEFZ"CE + °"� X PUa --------(Tit- ---------------- BmM:-W t{p ---------------------------------------------------------- (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---------- -------------------- REVIEWEDBY--------•------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------- - -- ------------------ ----------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:------------- -----------------------------------------------------=-----------------------------------------------`-------------------------------------- c-------------------------------------------- ------------------------ �_. _ r4_____y ___.._ c�J� --___ ____.Nor--_.______/tom—_____.____..____ __. ____-__ - 1 FINALINSPECTION BY----------------------- ---------------------------------------- Date-------------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-92M Revised 8.'59 F.P.Co.