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�J APPLICATION FOR-SANITATION PERMIT Permit No. __ ..Lz- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date issued .� / .p Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein d ribed. This application is made in compliance with County Ordinance No. 549. X, J B ADDRESS D LOC ION..! Owner's Nam _ _ -- - _ ---------•-------- - - - ---- � - - hon _ _ ,,�o Addres _ - �•4_ ° ---- -- ----- - - Contractor's Name_ � ----------------------- -- --- ---%---- -- •--- •------ Phone_. ---.3- 2 Installation will serve: Residence Apartment House ❑ Commercia r pj ' ❑ Trailer Court ❑ Motel ' Other ❑ Number of living units: - Number of bedrooms o� _ Number of baths �_ Water Supply: Public system _. Lot size .�_�,��x��J---------------•------- E] Community system ❑ Private Depth to Water Table "ft, rl Character of soil to a depth of 3 fee'f:.,Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay Y '� Y ❑ y ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑� N� 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.) Septic ank: Distance from nearest well_______________Distance from foundation--------------------Material ----------_--- No. of compartments--------•-----------------Size------•---------------- -------Liquid depth-------------------------- _ Capacity-•---- ------------- Dispos Field: Distance from nearest well_-----------------Distance from foundation._____.-______.._._.Distance to nearest iot line________._____-- Type of l lines-�_____a-------------------------Length of each line------------------------------Width of trench.----------------------------------- ------------- ------------------------- ----.-- Type of filter material----•--------------------Depth of filter material-----------------------Total length------------------------------------------ 47 Seepa _------------------""""- Seepa a Pit: Distance to nearest well...... Distance from f ndation_�_4__'�____.Distance to nearest lot Number of pits__.__/____________Lining materia,---Size: Diameter_ __ .� Depth Cesspool: Distance from nearest well_________________Distance from foundation___.________.______.Lining materia!__._____-______.___ C-" ❑ Size: Diameter = --------Depth--------------------- -----------------Liquid Capacity----------------------------gals. # ------------- Privy: Distance from nearest well______________________________________________ _Distance from nearest building----------------------------- ------------ Fl Distance to nearest lot line_____..__________________________ _ - - -------------------------------------------------- Remodeling and/or repairing (describe):__ j ----- --- ---- ---- -- ------ --- ------------- ---------•-•---------------------- -------- --= I ----------- --- --------------------- ----- -- ------------------------------- ------•--------------------z--------------------------------------------------------------------------------- ------------------------------ I hereby certify that I have prepared this applicat' in and f at the work will be done in accordance with San Joaquin County ordinances, State laws nd rule anSoegulafjo of San quin Local Health District. (Signed)._ - --.�-- --�--i`----- - ----------------------------- (Ow nd/or Contractor) By:------ f - - - - '-----------:- ---- ---- - - ------------------------(Title - - --------- (Plot plan, s of of, I on of stem in relation to wells, buildings, etc., can be placed on raver side}. a. ] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---,L,7_Y . __�--- -- -- r' --------------------- ------ ------------------ DATE---- -�----��..�---�---- ----------- - REVIEWED BY-------------------------------------------------- DATE---"--- -----------------------=------------------------------------------------------ BUILDING PERMIT ISSUED -------•-------""""-- Alterations and/or recommendations--------------------- ------------- -------------------------------- --------------------------------------------- x FINAL INSPECTION BY:_{�--- - / -----I- ------- Date-f -- ---- ------- �- - - - �- 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 E5-9-2M Revised 8-'59 F,P.Co. - �