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APPLICATION FOR SANITATION PERMIT Permit No. ....`z-G.�'- {� 1 (Complete in Duplicate) Date Issued ---- --------- This Permit Expires 1 Year From Date Issued 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------------7 .,; '` QT �y Owner's Name----------- '---------------- -------- Phone Address------------ -�;?!¢ 1 -----------• ---------------_----:----------------------------------------•------------------ Contra`ctor's Name----- Q� � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms _-7,-- Number of baths I--_ Lot size -------------------------•-------- Water Supply: Public system 9 Community system ❑ Private ❑ Depth to Water Table 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 ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well_________________Distance from foundation_-.-----------------Material-_____-._-______-_--__.-_---.-_-__-..-..-_-----. � ci/� No. of compartments--------------------- ....Size_.------•--------- ------------Liquid depth-------------- - ---------Capacity--------------------- Disposal_Fie4d: Distance from nearest well----47 Distance from foundation----1Q---------Distance to nearest lot line--,5---------- --------- X4 Length of each line------- -_��-_------Width of french v Number of lines-----=-1- =--- -- ---- g Type of filter material__R_Ce--------Depth of filter material---��-________-Total length______. ________________________ Seepage Pit: Distance to nearest well__--------------------Distance from foundation--------------------Distance to nearest lot line----------------- 0 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 well---------- --------------------------------------Distance from nearest building--____-.------_ ____________--.-.-.----.-. ------------------- El Distance to nearest lot line-------------------- ------------------ --------------------------------- -------------------- Remodeling and/or repairing (describe):__ - --- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I------------------------- I hereby certify that I have Aandulati pplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, d rul s of.the San Joaquin Local Health District. ----- -___to and/or Contractor) r S� ned _ <� �-1 { ----- ------- - - (Tale) (Plot plan, showing size of lot, locatia of sys em in relation to wells, Idings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------I c-- �1-------------------------------------------------------------------- DATE------- -` 7`C15' REVIEWEDBY------------------------------------- ---------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------- --------------- DATE-------------------------------------- ---------------------- Alterations and/or recommendations:------------------ - --------------------------------•----------------------------- . -----•-------Z<--------------•-------------- ,----E1Q H-------+SAS--- �� j' __-_tY�N_�-------- �� L.- ---R-------- R. ?------------------------------------------------------------------------------------------------------------------- - FINAL lNSPEC�ON -. . - - - - - - ---- -- - - - -- Date_ ----"�-'<- 7r--�-- -- ------------------- _------------ 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.