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APPLICATION FOR SANITATION PERMIT Permit No. ...�! (Complete in Duplicate) (o[� Date Issued This Permit Ex fres f Year From 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. JOB ADDRESS AND h LOCATION � " Owner's Name f ------------- � A_4�11.ay /'--A -�� - e-...../'-- Address---------------------- ddress------------------•----•------- ------- �_—_�Y�—__� ---- L _ — Contractor's Name_ _144j, ! __-__ Phone_ ____� Installation will serve: Residence$ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of-living units: __.. Number of bedrooms'__ Number of baths --k—.Lot size ----- __ Water Supply: Public system Community system ❑ Private ❑ Depth to Wafieir- Table ________ ft. Character of s it to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ . Clay Loam ❑ Clay ❑ Adob ] Hardpan ❑ Previ p ication Made: Yes ❑ No ❑ ,New Construction: Yes ❑ No ❑ 44A/VA: Yes ❑ No ❑ E INSTALLATION AND SPECIFICATIONS: ;= o septic tank or cesspool permitted if public sewer is available-'within 200 fee+.) is a stance from nearest well_______________Distance from foundation___________________Material----------------------_------------------------ No. of compartments---------- ---------------Size----~---=-----------------=---Liquid depth--------------------------Capacity----------------------- Distance from nearest well_A,Iacr-,t,�istance from found _ation_ ___oR--------Distance to nearest lot line....... _ Number of iines------I_________________ Length of each line_____ __ Width of trench- - `j�' � � Type of filter material ' �C.I[ Depth of filter material_____ ________Total length___ _�l_f---------- _______ See ag Pit: Distance to nearest well_�I_B. _____Distan rom foundation__ _.___.Distance to nearest lot iine__ ___-____-_ Number of pits----j-----------------Lining materia jD- -Size: Diameter.J-13- f.....Dept h.........p`-�__- -� Cesspool: Distance from nearest well-----------------Distance fro foundation--------------------Lining material-------------------------------------- El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line ---= --------- --------------------------------- Remodeling and/or repairing (describe)--------------- - ------------------------ ------------------ ----------•--------_--------•- -- .------------------•------------------------------- are -- ------ E -------------•---------------------------------- ------- ---- ---- -------------- --- - - --- --------- --- -- ----------- - ------ I -------------------------------- ----------------- ---------------------------- --------------------------------------- ------ - ------------------------------------------------------------------------------ I hereby c rtify that I have prepared this application and that the work will b dans in accordance with San Joac}uin County ordinances, ly and rules an .regulatio +h S in Lo salt District.+ � cc (Signe - f/., E r� .Y>L - Contractor) By:---------------------------------------------------------------------------- ----- - ------- ------------(Title)----------------------------- -------------- ------------------ (Pia+ plan, showing size of lot, location of system in rel n to wells, buildin , etc., can be placed on reverse side). F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ --------------------------------------------- ----------------•---------------------- DATE -•/7-� REVIEWEDBY------------------------------------•-- --- - - -- --------------------------------------------------------------------- DATE------------------------------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------== DATE •Alterations and/or re omm n ations: -------------------------------- tA . -�-- --------------- `- v--------- r ------------------------------------------------------------------- ---------------------------------------------------- ---------------------------------------------------------------------- ----------------------------------------------------------------------------------------------- FINAL INSPECTION BY:. .'--- Date Z'.-�Is -` �'U a SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast 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.