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APPLICATION FOR SANITATION PERMIT Permit No. l..r ._1_.L. .. (Complete in Duplicate) (� This Permit Expires 1 Year From Date Issued Date Issued i 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- �qv -- -_ ----- - ---0�Q------------------------------------------------•------------ Owner's Name-----.- ame ------ -------! - Phone..._.. Address-------- ------------------ ------ Contractor's Name Phone ►••�� - , Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ s�rMotel ❑ Other ❑ Number of living units: -/-'-Number of bedrooms .PSr_ Number of baths _/-- Lot size ---f-��- �/��_f------------------ Water ----------------Water Supply: Public system; Community system ❑ Private ❑ Depth to Water Table -7%,-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑. Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes [❑ No New Construction: Yes ❑ No FHA/VA: Yes [yYNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 780 feet.) Septic To Distance from nearest well.__----- -.Distance from foundation-_/e-.___--,.Mate i4I__ r- --J-----. No, of compartments......Z---------------Size_ - ------Liquid depth____-- __. ..--------.Capacity ... Q_--• Disposal field-. Distance from nearest well----- _.._.Distance from foundation.--..t��__-_.._..Distance to nearest lot line:._-_---_ [ � Number of lines_________ ____ ______ ength of each line------ _ __�_ Width of trench-- 1� ��-=--p--- �-- -�---------------------- Type of filter material � epth of filter material___.__ O__:___.__.Total length--.-____. -�________________________. Seepage Pit: Distance to nearest well----------------------Distance frQrn fo ndation_---Z99-__---.Distance to nearest lot line__. ----- Number of pits-----�__-__-------Lining materia l__./ �-_Size: Mameter_..Sg__------Depth----avq�-._------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------_-_.-_----_-----_---_------. ❑ Size: Diameter--------------------------------------Depth----------------•-----------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------ ------------Distance from nearest building__-_________._-_---------__-_--_._____- ❑ Distance to nearest lot line------------------------------------------ --------------•------- --- - ------ ------------------------------------------------------ Remodeling and/or repairing (desc�ibe�:+^_ .-__-` = - ----------------------------------- ------------ ---------------------------------------•-•--------------------------_--:------------------------------------------------------------------------------------------- - 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 r s and regulations of the San Joaquin Local-Health District. (Signed) --------- (Awc�a+ or Contras+or( By:---------------------------�------ ------------ ---- (s?JV-1----------------------------------(Ti+le)--- , -- (Plot plan, showing size of lot, locati system in relation to wells, buildings, etc., can be placed on reverse side). FORD ART USE ONLY APPLICATION ACCEPTED BY---- w ------ DATE------- � Q------------ REVIEWED BY------------------------------------------------ ----------------------- ---------------------------------------- DATE---------- -------•-•-------------•----------•------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ----------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-------- --------------------------------------------------•--•--------------- ---------••-------------------- ---------------•-------------------•------- ---------- ---------------------------------- ----------•------------------------------------------------- ----------•----------------•---------------•----------------- --------------------------------------------------.- F]NAL INSPECTION BY:-- - - ----- - - -- --- ---------------- Date---- ----------- ------ ......(0--- ---------------------------- 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-9-2M Revised 8-'59 F.P.Co.