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fPPLICATION FOR SANITATION PERMIT Permit No. ,....`....4 ..rf.. (Complete in Duplicate) v/ _ Date Issued -��- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh 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---- ------- ------------------------------------------------'-------------------- ----------------------- Owner's Name -- -------- Phone-------------------------•------ ' ----' ',---'-----------------�- �� h--------------•----------- Address------- --- --�•-- - -•------ --- --------------------------------•------------•-•--------- Contractor's Name '•.• - ---------✓---------------------------------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court,❑ Motel ❑ Other ❑ a Number of living units: __. _._ Number of bedrooms Number of baths _L___ Lot size ___!_ f ......_----------------------___ Water Supply: Public'system Community system ❑F Private ❑ Depth to Water Table eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ r E Previous Application Made. Yes ❑ No New Construction: Yes KT`I"o ❑ FHA/VA: Yes Rg-No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r., --- le--------Material----6-- ._.,..... Septic Tan Distance from nearest well `� Distant f om foundation____ No. of compartments__-___.r2r------ f5ize__s _ Q__-___Liquid depth____ _).______..Capacity...__, Disposal Field: Distance from nearest well.... ^ __ _.Di. ance,from foundation__!Q___-------Distance to nearest lot line-4-— ., Number of lines____-�________ ____ _ ______ __Len th of each-line--------- .�`� Width of trench-_•�_�, ________________._ - ---------------- ®' Type of filter material _Depth of4filter mate ria l__,_0�PA--------Total length-----/5; ----------------------------- �.. l Seepage Pit: Distance to nearest well_._._- ^ ____Distance fr m fou dation_:__.��_______.D since to nearest lot line__ Number of pits--�-------- g �f�c Linin material:F� -- Size:,Diameter__ _________________Depth---1a-.-.------------:-- Cesspool: ,Distance*from nearest:waif----------------:Distance fiom foundation-_--*..............Lining material__._____.__.__.____________________ ❑ Size:'Diameter--------------------------------------DeOh------1 - - quid'Capacity -gals. i Privy Distance from nearest well_ ___________ __ _______________._Distance from'nearesfi building_:__._________._________ ------------ ❑ Distance to nearest.lot.line-------------------------------- ---- ------------ ---------------- --------------------------- -------------------------------- Remodeling and/or repairing (describe) ------ ----4---*' ____- ----- ----------------------------------------- -------------------------------------------------------------------------------------------------------e -------------- ---------------------------------------------------- - ------------------------•----- -----------------'-----r-- -------------------------------- -------------------------------------------------------------._ -----------------------------------------------------.---- ---------------------------------------------------------------------------------------------- ----------------------------------------------------- . : ........ I hereby certify that I 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 s _ � {� Contractor) �7 (Signed) I -----------------------------------------(Title)i s (Plot plan, showing size of lot, location of . stem in relation to wells,,buildings,.etc.,,.can be placed on reverse side). FORD PARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- ----- - - ------ -- ----=-------------------------------------- ------------- DATE------- - ! REVI,EWED BY-------------------------------------------- ----------------- ---- ---------------------------------- DATE--- '--- ------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------- ---- - ------- ------------------------------------- DATE------------------------------------------------------------- { Alterations and/or recommendations:-=-------- ------ '------------------------------------------------------------------------------------------------------------------------------ - ---- ------------------------------------------------------------------- ------------ - - - ----- --------- ------------- _ ---- ----- 6W !�' ....... --------------------------- ----------------------------- -------------- - ---- -------- ------ ------------------------ ------ -- 3 { .4 +. zzv 4� a Ile FINAL INSPECTION BY:-----_- i ------------------ -------- Date fd � �.. 'r SAN JOAQUIN LOCAL HEALTH DISTRICT t f X8;14 130 Soufh American Street 300 West Oak Streat x,132 Sycamore StreeNorth "C" Scree# Stockton, California Lodi, California Manteca, California �r' Tracy, California E t 5 � 3 ES-92M Revised 8.'59 F.P.Co.