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APPLICATION FOR SANITATION PERMIT permit No. ...11__ -7..- (Complete in Duplicate) � : d 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 d i fr*e;'j,7ed scribed. This application is made in_( p nc i h County Ordi nceNg, 549. (�3 - 9CJ(Q JOB ADDRESS ANb LOC TION..____.___ _ _ --- ---------ate ` lh --------- Owner's Name ----------------------------- -------- = Phone.9_02t ------- n rj Address Z tA ------•-- ----�k..� _ Contractor's Name i t ------------------------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence a Apartment House ❑- Commercial 0- Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---V.- Number of bedrooms --3 Number of baths ___I____ Lot size -------7 --- - ________________-_____ Water Supply: Public system ❑ Community system ❑ Private g- Depth to Water Table _j_!;._ ft. Character of soil to a depth of 3 feet: Sand F2( Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes V, No ❑ New Construction: Yes ❑ No54, FHA/VA: Yes ❑ Noa2k TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e.tic T nk: Distance from nearest well-----------------Distance from foundation--------------------Material_ d No. of compartments Size------- -------------------------Liquid depth--------------------------Capacity---------------------• "Ii I -------- 1 -� Dispo Fiel :" Distance from nearest well._1� _------Distance from foundation______) _ Distance to nearest lot line--- tuber of lines---------__ {- Length of each line-------��-------------.Width of french. .2-1 -- L} TYp Depth of-filter material-___._I.2--__-------Tota! length---------�Q_---------------------- e of filter material_____________ Seepage Pit: Distance to nearest well----------------------Distance from foundation____.___•___-___-__.Distance to nearest lot line----------------- El Number of pits----------------------Lining material--------------.--------Size: Diameter----•------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from found ation--_._.--------------Lining material------------------------------------- I ❑ Size: Diameter--------------------------- ----------Depth----------------------------------------------------Liquid Capacity- -------------------------gals. Privy: Distance from nearest well___________________________________________.--.-Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line------------------------------------------ Remodeling and/or repairing (describe)_----------------------_-------------_---------------- --------------------- ---•---------------------------------------------------------------------------------------------------------------W7 Y--------•--------- -------------------------------------------------------------------------- -------------------------- ---------- -----------------------•---------------------------------------------•------------------------------------------------------------------------------------------------------------------ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfa laws, and rules and regulafi of the San Joaquin Local Health District. (Signed)----- --------- - ------ --- --- --------------- --- --------------------------------- ---(Owner nd/or Contractor) By:- - ----------------------•-------------------------------------------------------------------------------------------- ......._{Title)---------- --.- ----------------------- - -- --- ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can,be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------a), -------------------------------------- DATE---------------- --------------------------- -- I -------------------------------------BY --- DATE-------- �? BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------- ------------------------------------ Alterations and/or recommendations:------------------------------ - ------------------------------------------------------------------•-•--------------- - -----------------------------------------------------•----------------.-.--- ---------------------------------------------------------r -•-------------•------------------------------- -------------------------------------- --- - - C' ..R.-ry-..- ' FINAL INSPECTION BY----------- ------ Date - 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-9-2AA Revised 8-'59 F.P.Co.