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APPLICATION FOR SANITATION PERMIT Permit No. .to.. 131 (Complete in Duplicate) / This Permit Expires 1 Year From Date Issued 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. JOS ADDRESS A CATION----- ------- ---------- Owner's Name ----------*4___(9_1------- UlC,! Phone ------------------------------ - ------- Address ------------------------------------------------- Installation ---- ------------- -------------- - Contractor s Name---------- --- - s �" "� 1� ---------- ------------ - ----- Phony Installa i tuwill ber of serve: : Residence Apartment House ❑ Commercial ❑ Trailer Cour# ❑ Motel ❑ Other living ____ Number of bedrooms Number of baths ___1___ Lot size ----- /e��.-X---�� ------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ado b Hardpan ❑ Previous Application Made: Yes ❑ No ] New Construction: Yes ❑ NOP FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pt- f: Distance from nearest well-----------------Distance from foundation--------------------Material-_____-__-_____-______________---_____-__-____. No. of compartments-------------------------Size---------------•----------------Liquid depth--------------------------Capacity-------------- -------- Dis a al�ie Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- ~' j51r Number of lines-----------------------------------Length of each line----------------_-----------.Width of trench--------------.-_------------------- - Yp - P � ------r 9 ----------------- ��l �� T e of filter material------------------- - ---De Depth of filter material__------- --- --- - - -- - - - _ eta length-- ------ --- -----•-- ----- --- - Distan to nearest lot line-- SeeF�a�e Pit: Distance to nearest well_-___��4�Distance fr foundation_-..- O--- f� { _________Linin material_______ _Size: Diameter De th__.� 7� Number of.pits------_.�.- g p Z—S Cesspool: Distance from nearest well_______________Distance from foundation--------------------Lining material-------------------------------------- 0 Size: Diameter----------------------------- ----- -Depth------------------------------------- --------------Liquid Capacity----------------------------gals. l' Privy: Distance from nearest well---------------________________-_____-_______-_Distance from nearest building-____.___-________________-__--------_. ❑ Distance to nearest lot line----------------------------------------------------------------------- t --------------------------' -' 4 Remodeling and/or repairing describe) Lsr ------f---- 5-3------------- i��---- ------ ------ -- ------------------ ------ I - ---------------------------------------------- --------------•-------------•------------------ --------- ------------ ----------------------------- I hereby certify that I have prepared this appli 'on and that the work will be done in accordance with San Joaquin County ordinances, State laws, and r and regula4ns of t San Joaquin Locai Health District. (Signed) ---------- r - caner and/or Contractor By:---------------------------------- ------------- r ---------------(Title)---- -- -------- t (Plot plan, showing size of lot, ''locatio of ystem in relation to wells uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ DATE '- ��. _. !.p REVIEWEDBY------------------------------------------------- - ----------------------------------------------•---------- DATE-------------- ----------------- ------------ -------- BUILDINGPERMIT ISSUED----'`-------------------------------- --------------------------------------------------------- DATE------------/---------------------------------------------- Alterationsand/or recommendations:---------------------------------- ------------•----•----------------------------------------•-•-----•------•--------•--•-------------------------------- ---------------------I---------------------------------------------------------- ------------------- - ----- ----------------------- ---------------------------------------•---------------------------------------------------------------------•-------•------------------•------------------- 'I -----------------•- -------.--------- ------------------- + I Date-------- (------------ --- --------- FINAL INSPECTION BY---- --- ---------- -- ------- --- 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 0-'59 F.P.Co. `