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APPLIC' -7 ON FOR SANITATION PERMIT Permit No. ._!__ .f-, f (Complete in`Duplicate) { This Permit Ex fires 1 Year From Date Issued Date Issued ------041 Applicafiio 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. 'JOB. ADDRESS D CATION._..___.-_ �1 -"---------------- -- ------------ Z&------------------- ---- i` Owners Name- ------ ' - f ,, Address-,------------------ -- -- ------ Phone-----•-----------•----•------------- -------- �-- --- ---- Contractor's Name-A-1 - --•--- ------------------••----•-----------------••-------- -•-------:----- -- - - , ----------------------------------------------- Phone. ---•___ __ ___ Installation will serve: Residence Apartment House ❑ Commercial _ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:/-- Number..of bedrooms __ ____ Number of baths __ f Y ,.,,� f'--- Lot size ______ _ __ Water Supply: Public system � _._��_______________•- PP Y� y E community system ❑ Private [],,.Depth to Water Table �� ft.; y Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sand Loam ClayLoam F Y , ❑ r ❑ -Clay❑ Adobe Hardpan ❑ Previous Application Made: Yes'❑ No �ew Construction:fYes ❑ No [4_ F-NA/VA: Yes ❑ No ❑ T Rf OF INSTALLATION AND SPECIFICATIONS: f o septic tank or cesspool permitted if public sewer is available within 200 feet.) is nk a. Distance from nearest,well_'---------____Distance from foundation__________ _____ __ Material- _ No. of compartments' - ----Size------•------------------------Liquid depth-- Capacity . Disposal Fie d: Distance from nearest ell - - - -- r Distance from foundation__ ,.Q_--._____-Distance to nearest lot line,_ Lam' Number of lines_ __-.-_ .---_' -Length of each line__- -Y Type of filter material- . Width of trench-.._ / __ 13Z _ __Depth of filter material___IF_ '_ ___ r Total length--------------•--. �_ See a Pit: Distance to nearest well- _ ' . p.ge —Distan a fr ` f ndation _ ___ Size:'p Distance to nearest lot line_______�___._ IJP Number of pits. __._______-_Lining matarial iameter'_: '� Cesspool: Distance from nearest well------------ _Distance from foundati - ---.Lining material-:..--._-.___ ❑ Size: Diameter----------- ----------=----Depth--------------"--- - --------Li uid Capacity-. gals. ,. ,. q P tY " ----------- Privy:. Distance from nearest well____________________ ____--.____--___-__Distance from nearest buildin ❑ Distance fo nearest lot line ------------------------------"- - ---- -- ----------------------------- Remodeling and/or.,.repairing (describe)---------------------------- ------------------------------------ - ---------------------- -•------------------------ •--- ------ --- - ----------- ----- ----------------------- --------=---------•---------------------------------------------------------------------------- I here certify th I have prepared this a plication and that the work will be done in accordance with San Joaquin County ordinance$f^S' fe` aw and rules nd regulati s of the San Joaquin Local dealth District. (Signed)_ — " f tn > -" --------------•-- BY� -------------------- -------- '� Contract - -. : caner and/or - -1 -- ---------- - -- --------------(Title - or) {Plot plan, showing size of lot, location of sp m in relation to wells, b(I ngs, etc., can be placed on-reverse side). F R D P RTMENT USE ONLY APPLICATION ACCEPTED BYE........ DATE______ ------ s--,---------------------------------------------------- REVIEWED BY -- - ---------------"- BUILDING PERMIT ISSUED---------------• --'--------- ------ DATE.------ -- -------------------------------------------------- DATE---------- - "------- Alterations and/or recommendations: �.___._____..__-- ---------------------------- ---- ----•------------------=-----------•----•------------•------------- -�" --"-- "---- -----" "-- --- - -- - - - - -------------------- FINAL INSPECTION BY: ------7 . - _-_ -------------------- Date--------- -_ -_ _4111lu x 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 8-'59 F.P.Co.