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o APPLICATION FOR SANITATION PERMIT Permit No. ..... v/✓rl a a (Complete in Duplicate) ___�-�- Q 4 Date Issued This Permit Expires I Year From 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. r I JOB ADDRESS ANDLOCsA'T)ION-- --�---;� D--- -----------------------------------•-----------"--- Owner's Name----------- d :.. Phone------------------------------ ------------------------------------------------------------------------------------------------- Address------------ --------------- ---- ------------------------------------------------------------------ ---------------------------------------------- Contractor's Name- --- y Phone Installation will serve: Residence (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J--- Number of bedrooms _ ^_ Number of baths --4-- Lot size ---------------•-------- Water Supply: Public system [ ommunity system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam El Clay Loam El Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes El No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic tank or cesspool Qermitted-if spublic sewer is available with 200 feet.) ' Se tic Tank: Distance-from Distance rom .foundation 40------ MafVial--- _ p �! compartments... - ---.Size_ .. Liquid de fth Capacity No. of __ __ _____ " wk �Q's_F__.Distance to nearest lot line____ __________ Disposal F�eld:'�L f-Distance from nearest well-__.-_ ._'.'_Distance from foundation___ F Q Number of lines------------ Length of each line---FQ -i-_,`-- =---Width of trench_..__ - __._______._________. Type of filter material___-q (/ •Depth of filter material____. ��----.Total -. ______ -_--. DistanceTto nearest lot•line�' .___.__ Seepage Pit: Di`stance-to-nearest-well-__ -- bistanee-frond ioundafioh _____ t ___-. t Number of pits-------/.____---ekining material---Xp��-Size: Diameter____ `J� Depth `' Cesspool: Distance from nearest well ._-____ "__._Distance from foundation...............___.Lining material---.--------------------------------- I ElSize: Diameter------ ---------------=----------- Depth-----------,---- ----;-----------------------------Liquid Capacity------- -------------------gals. Privy: Distance from nearest well-----r------- - _------- --.-Distance from-nearest-building----- ------------------- ] Distance to nearest lot line':'-------- C------- - ------ ' - - r • lf%v__ iZ i 3 Remodeling and/or .repairing [de�ribe).--------i-- ----- -- - --`A- -' �-"- �,.�--- -- - -= s � I - '- 1 � w a - F ..._- _ - --. -. ---------------__- ---------------------------------------------------- ------- ----------- - I hereby certify that I have prepared this application and that~.the work will be done in accordance _""""" San"""" _-uin -. ------- -------- --- nce with San Joaquin County ordinances, State laws, and rule and regulations of the San Joaquin Local Health District. I �� -- ---- --- � ( antract (Signed)---------------------------- ---- - - --------- .1 -'- - -----,--- = -- �- ---------------------•-------- ------------moi - .1 -------------------------------- Title--- By:-------------------------------------------•-------------- (Plot plan, showing size of lot, location of tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYDATE------- - �� ------ i X--,--- REVIEWEDBY-------------------------------------------- --------------- ==- = ==-:_ - =_-= ---__DATE---------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- --------------- DATE------------------------------------ ------------------------ Alterations and/or recommendations:-------------------- --•---------------------------------------- j -- t. l ------------ -----------------= _ --- -- -------------------- -------------- --------------- 'A ------------ --- - ------ -- ------------------------------ ---------- •------- - ---------------------------------------------------------- ---------- ------------ - - � ----- ------ _ -------------------------•----------------------------------- ---------------- FINAL INSPECTION BY: - -------------------------- Date. = Coa I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh 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. -