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APPLICATION FOR SANITATION PERMIT Permit No. ..l..z..a.�a'.. (Complete in Duplicate) Date issued ._/__`! .d___.. This Permit Expires 1 Year From Date Issued _ p lication is hereby made L 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. 9. JOB ADDRESS'AND LOCATIO _ ---------•----- �41 Owner's Name----- C-1 ------- 1-•-----•---------------- - --- -------- ---- -:---- Phone,_..----------------------------- Address----------------------- II; ='! -----------•---•-------------- -- ------•--••--------------.--•-- - Contractor's Name. �t �4 � 4 -__--------- Phone--_ -- .....��Q f�� I Installation will serve: ResidenceA- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unit ___ Number of bedrooms Y Number of baths ____ Lot size ________CC :_ __�__ ..__l__► __Q._ _ Water Supply: Public system ❑ Community system ❑ Privateo. Depth to Water Table _______ ft. Character of soil to a depAtf. 3 feet: Sarid ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe$d Hardpan ❑ Previous Application Made: .1Yes ❑ No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION Ai`ND SPECIFICATIONS: j (No septic tank or cesspool permitted if public sewer is available within 200 feet., tic Distance l _ from nearest well_________________Distance from foundation___________________.Material_____________._.__._____.________-_ ____-__.-__. z No. of compartments--------------`-----------Size--------------------------------Liquid depth--------------------------Capacity----------------------- sal'F:reH: Distance'1rom nearest well---0--L_____.Distance from foundation_�_E2___....Distance to nearest lot line------- Number of lines______/__._."__.__ •_�-___Length of each line-----�_�__ --------- Width of trench----- ��____-_-.__---- 4- „ / f' Type of filter matenaL� __�4 _:Depth of filter material____1 -------Total length--------,� ._'_.-______________.__ Seepage Pit: Distance, nearest well.______________�___Distance from foundation___.____.-_______.Distance to nearest lot line______________.__ ❑ Number of pitsLining material - - Size: Diameter - - Depth - - - ��,from Cesspool: Distance ---------------------- ---------_ ---------- - ----------------- - --- -- ------------------------ -nearest well________________Distance from foundation ____._.__._____.__.Lining material_____-____..__..________________...__. �F1Size: Diaeter--------------------------------------Depth---•---------------------------------------------.--Liquid Capacity----------------------------gals. I Privy: Distancelfrom nearest well---------------------------------_---------------Distance from nearest building----------------------------- ❑ Distance'to nearest lot line------- ------------------------- -------------------------------••-----•----------------------------------------------------------------- 4 S Remodeling and/or repairing (descri ----.__- ------------------------------ '1------------- --------... ----------- '-----,•----------- -------------------------- ----------------- ---------------------- --- --- �f ------ -- r ----- ---------------------------- -----------------------------------------------------•-•--_----------------_------- ------------------------------------------------------------------------------- I hereby certify that I Piave prepared this application and that the work Vill be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I � C(Signed)---- ontracfor) B -------------------------------11l------------------------------------------------ = -------------------- Title-------------------- ------------- -- (Plot plan, showing size of lot, location of system in relat' to wells, dings, etc., can be placed on reverse side). 01 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- y 4-* DATE �' REVIEWED BY---------------------- -II' --------------------------------------------- ------------------ DATE-------------------- --- BUILDINGPERMIT ISSUEDA------------------------------------------------------------------------------------------------- DATE-------•-------;-------------------------------------------- Alterationsand/or recommenldations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ----------- ---------- ---- �� --- C- ----------------------------- ---------------------------------- �p '� FINAL INSPECTION BY:-- * .r Date--- T--------- - ----- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streef Stockfon, California Lodi. California Manteca, California Tracy, California E5.9-2M Remised 8-'59 F.P.Co.,