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APPLICATION FOR SANITATION PERMIT Permit No. , :...... a !/ 6 r (Complete in Du Plicate ) Date Issued ___._._/�_�..•_v This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health Distric#for a permit to construct and install the work herein described. This application is made in comptliance with County Ordinance No. 549. . .. _. S ------•--------------------•--•--------.•----•-----------------�------- JOB ADDRESS AN LOC TION..___--__/ -- - - ---- -------- ----- - S 8, Owner's Name ! = F Phone(V-_ .�-------- ----� Address---- ;---- -------------------- ----------------t------••------ Contractor's Name----------� ----- Phone_ l�- 4_ _. Installation will serve: Residence Apartment House ❑ Commercial.❑ Trailer Court ❑ Motel ❑ Other ❑ f'`l- �} i Number of living units: ,�- Number of bedrooms o -- Number of baths _ .Lot size ____, --- -1-1 "--•-------- Water Supply: Public system [�ommunity system ❑ ! Private ❑ Depth to Water Table,�, Character of soil to a depth of 3 feet: Sand E] Gravel Q Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑:,' Previous Application Made: Yes❑ No New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I I (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) . .4 h tic Distance from nearest well------------------Distance from foundation-------------------Material------------------------------------------------- No. of compartments ------Size---•• Liquid depth---------------- Capacity----------------------- -------------------------- s eld: Distance from nearest well-___- ---------Distance from foundation__---__:.__---____.Distance to nearest-lot,line-----------------, Number of lines----------- -----------------------Length�of each line------------------------------Width of trench. -- -- X .- Type of filter material--------- Depth of filter material----------------------- length____.____________'______�_--------_-.__-- Seepage Pit: Distance to nearest well. __ Disfince r _fo ndation__/�1----------Distan'c'e to nearest lot line: 5-.-____ d If Number of pits---- _ ------Linin maferial_� ,_.,,0Cr Size: Diameter.----,3�--------Depth----� ----------------- Cesspoal: Distance from nearest well________________`Distance from foundation--------------------Lining material----______--.._____.____--.____-----. 1 1- ❑ Size: Diameter_--- -----:_D'epth---------------- - --- --------- ----- Liquid Capacity-----------'----------------gals. Privy: Distance from nearest well_ . .�:___________.._____ -__------ ---Distance from nearest building ---------------�---------------------- V1: ________ ❑ Distance to nearest lot line- I- *-------------- ----------------•-----------------------------------=------------------- ------------------- -------------------------------------------------------- � Remodeling and/or repairing (describe):------------------ ------------- --------------------E---------I----------------------- '= - - -------------------- ---------------------------------------- i _______________________________________ ___________ __________________ ________ _ __ ___ ____________________________________________________________________________________________________________________________________________________________ _ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e laws, and les and re uI tions of the San Joaquin Local Health District. " ' Oner and/or Contractor) ---------- BY= --------- "'-t s -------- -- (Title] -------------- -- ------------- (Plot plan, showing size of lot, location of syste i re ation to wells, buildings, etc., can be placed on reveise side). FOR DEPARTMENT USE ONLY 9� APPLICATIONACCEPTED BY----.- =.: -------------------------------------------------- DATE------& 1 -------6_0------------------------ REVIEWED BY------------------------------------------ ----------------------------------- ----------------------------- ---------- DATE----------------------------------•-••---------------------- - - --- -- BUILDING PERMIT ISSUED-------------------------- - -------------------------------------- DATE-----------------------------------'--------_----------------- Alterations and/or recommendations:----------------- --- ---------------•----•-----------------•------------------------------- -------------------------------------------------------------------- ----------- ------------------------------- ----------- ----- --------------- -------------------------------- --------------------•- --------------------- ----------------------- -- -- - ------y--- $ . . . --- ---- ------- o --?, ------------------- ----------------- ---- --------- -- - ----------------- ---- FINAL INSPECTION BY ---------- - -------- -------- - ----------------- Date. - ^C� =------------------------ 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.Ca.