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�1ez .� APPLICATION FOR SANITATION PERMIT Permit�T�..._�.�-�..�. [Complete in Duplicate] �'. 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 and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------ - ----------- -_-• l__/Y_ ' �i' Via- --------------------- ./e�j7 Owner's Name -- f --- /I.0 --.... Phone------------------------------------ •�1- Address ---------- ----- Contractor's Name-- =� lS ,. C°'= Phone. -- .r Installation will serve: Residence Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: --- Number of bedrooms .0- Number of baths _/---- Lot size -----ZX- -, 1 �C?--------------------'_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ElAdobe& Hardpan El Previous Application Made: Yes E] No/W New Construction: Yes E] No FHA/VA: Yes E] No E]TYPE OF INSTALLATION AND SPECIFICATIONS: (No(No septic tank or cesspool permitted if public sewer is available within 200 feet.) p p ------------------------------ e— f n s Liquid �r .Material "9YY e tic � : Distance from' nearest well-----------------Distance from foundation=---------de th---_._______.....---__- -_Capacity/� No. of torr, artments------------------- ------Size..------------ p p Y Disp sal Field: Distance from nearest well. . - . Distance from"foundation-_ -- - -- - �1 �'. �Q_____--_-Distance to nearest lot line.---�--. Number of lines----- Length of each line___- ----------Width of trench--------?-Yit-----................. --------------------- Type of filter mate a€_---- _ ------Depth of filtermaterial-----------------------Total length-------------------- �-- -- p Seepa Pit: Distance to nearest well-- _� -I----Distance from (foundation____lQ_._____..D- t ncp,o nearest lot line-IS ry, Number of pits------ -- .0 material---/ ocrl -.S'ize: Diameter.-rX .....--__Depth--_.Z.�f-----.__ _---- ;'U ess ool: Distance from nearest well-----------------Distance from foundation______--------------Lining material--_____--.-------_------------_---._. ❑ Size: Diameter--------------------------------------Depth-------------------------- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well____--'--'__---------------------------- .---.-Distance from nearest building------_------- _-__--__---.-.- ❑ Distance to nearest lot line--------------------------------------------- ----------—---------------------------- - A` { - Remodel in and/or repairing (describe):------- S ---------------------------•---•-------------•----------------.. Q �,� ' .0 -------------------------------------------------------------------- gra , - --------•----------------------------------- -------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules-and regulations of the San Joa uin Local Health District. {,--(Signed)------- ------- � -----I��•�l�,S-��- -------� -,��'---- , --�°`-�--r----•--------- -- ]Owner and/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 D ARTMENT USE ONLY APPLICATION ACCEPTED BY--- - DATE fir' �� 6 REVIEWEDBY--------------------------------------------- ------------ ----------------------------------------------------------- ----. DATE------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------ Alterations and/or recommendations:-•----------------------- -----------------------•---•-•------------------•--------------------•-•--•-•----------------------------------- -------------- f - -- -- ---•FINAL INSPECTION BY:-- , -------------- Date------------------ SAN --------------- -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.