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APPLICATION FOR SANITATION PERMIT Permit No. 1 _ .. 1 (Complefe in Duplicate) ,! This Permit Ex fres 1 Year From Date Issued 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. JOS ADDRESS AND LOCATION____ - ) �d�_-.-- G i.!_-.._. f,� .�,,e .,e/------------ Owner's Name_____ "�__""_-_-_ , -- --- �'[d• --- ------ Phone Address___.._.___._ -= -_----------- Contractor's Name--------- - � ---------•--�--- ______________ _ ! _�./ ��: --•- - ----x----•- ---� ==lr?-�,�s'i�---9►��C3�r�.1--�-"'••��----'-- - Phone--7-"'_--'� Installation will serve: Residence^Apartment House ❑ Commercial [:1 Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: -1----- Number of bedrooms2--_ Number of baths _-_!___ Lot size -------.%9-B---, Wafer Supply: Public systemx Community system E] Private ElDepth to Water Table _V0 ft. Character,of soil to a depth of 3 fee}: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ AdobgA�f Hardpan.❑ Previous Application Made: Yes ❑: No ❑ New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ No ❑ TYPE OF,INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept• jnk: Distance from nearest weft___________ ___Distance from foundation-------------------- 11Materia#------- ----------- --------------------------- it ---- --------- �----- r No. of compartments------------- - ----------Size---------------•--- -----------Liquid depth----- ---------Capacity--- ipos I�j Distance from nearest well..*Abd�istance from.foundation.____1(9--(-.Distance to nearest lot line_�-.-_ 1 Number of lines______-- d „--" 1 --- ---- -____Length of each line----- __Width of trench. Type of filter material-_-,.___ __-_ �� ""-"-----`--------- _Depth of filter material____ _ Total length `" /rte----� ----- 9 ��------------------------ See e„Jt; Distance to nearest well _ ' ��„_!1 _pistance from foundation--__�� -------Distang,to nearest lot line;�f""""._ \ q Number of pits---------I______ _____Lining material Diameter_ V Cesspool: Distance from nearest weil-----------------Distance from foundation.__-----------------Lining r - materia❑ Size: Diameter--------- ----------- ---------- -De Dept -- ----------- -- ---------- �---------- ----_Liquid Ca acitl _ -_ _- ----- Privy: Distance from nearest wellDY-----------------------------.gals. __________________ _____________ stance from nearest buding____.___-________-__-----_----- _El ' Distance to nearest lot line___________________________-_ - ------------------------------------------- --------------------------- Remodeling and/or repairing (describe)______ __ ------------ -r--------- •------ ------------------------------------------- ----- +�GC --------------------------------------------- l.hereby certify that I have prepared th' application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a rule and re ati ns of the San Joaquin Local Health District. �j (Signed)•------------------ c "[ I -- r ".____-_. Owner and/or Contractor) BY ------------------ {Title) ' •�- (Plot plan, showing size of lot, location of system in relation to wells, buildin s, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - DATE------ - REVIEWED BY----------------------------------- - -� " -- ---------- -----------•-------------------- DATE--------'--- -- -BUILDING -� - BUILDING PERMIT ISSUED--------------------""-- - DATE- _----Alterations and/or r,commendations:___--__._____.____- ------------- ---------------------------- - -------------------------------------- FINAL INSPECTION BY: - V �- ---------- Date - , ------ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 1300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California I Lodi, California Manteca, California Tracy, California ES-9-2AA Revised 8-'59 FP.Co.