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APPLICATION FOR SANITATION PERMIT Permit No. ..f __-<.. l (Complete in Duplicate) l > b.- This Permit Expires 1 Year From Date Issued bate issued __ �__�Ja 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-- _ 3-----,h --- ------------- Owner's Name---------------------------f �' (a��-`"fir ----- Phone Address_.--_--------------------------�.^1. --------/C Contractor's Name------------------------- f----------• ---------- ---------•----------------------------------- Phone----_--------------------------- Installation will serve: Residence [& Apartment House ❑ Commercial (] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.�____ Number of bedrooms _ - Number baths __ -_ Lot size ___ _ _" --f-r�._ ___________________ I # , Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 6__ ft. Character of soil to a depth of 3 feet:L=Sancl ❑ Gravel ❑ Sandy Loam Rr Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 0q�New Construction: Yes M-'No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] _ Septic Tank: Distance from nearest well____ _Distan from foundation_1,6?_ Material --- -------- "" ` "/ *� . i f----- - No. of compartments_.___-- ___.______..Size _ ' __.___Liquid depth__._____�-_-.________-Capacit) Disposal Field: Distance from nearest well------------Distance from foundation_ istance to nearest lot linee _____�.__-..... ® Number of line-------3__-------"_________ __ Length of each line_�0V.J__ - �'--Width of trench_.. ._ __. Type of filter Material----5 '-Depth of filter material-----� -----------Total length.......L_�__C.�_ _________-.____ VJ Seepage Pit: Distance to nearest well_-___.:_________.___Distance from'foundation__•_______________.Distance to nearest lot line____-_.________- X ❑ Number of pits----------------------Lining material--------•--------------Size: Diameter-----------------------Depth----------------------- l .,,,, �. _\ Cesspool: Distance from if well_________________Distance from foundation__ _____---___._____.Lining material__._______..__..__`__._______..___. ((O„ ❑ Size: Diameters------------------------------------Depth----------------------------------------------------Liquid Capacity-.------------------------ --gals. ` A Privy: Distance from nearest well---------------------------------------- from nearest --------------- (A V--``1 [] Distance to nearest lot line------------------------------ Remodeling T and/or repairing (describe): ------------------ ---------------- ---------- '-=---------------'------------------------------------------------------------------ . I �r- f--- ------- -----------------------------------------------------------'-----------_._-------•----•-----------------------------•--------------------._.._.... 1 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 Joaquin Local Health District. 00 e 1. -------------- --------------------------------------------------------------------- (Owner and/or.Contractor] f By:----------------------------------------': --------------------------------------- -------(Title]---- - -------------- (Plot plan, showing size of lot, location of system•in•relation_to wells, buildings, etc., can be.placed on reverse side). FOR DEPA_RTT T USE ON ------ ---------- ATE----/� t _14APPLICATION ACCEPTED, BY -------------- t REVIEWED BY------- ----------------- DATE:------------------- - BUILDING PERMIT ISSUEDDATE------------------------------------------------------------- - •-------------------------- v------------------------ ,_ Alterations and/or recommendations: w=: --------------- -- --=-=--=----=------- -----=`---•---------------• t-- --------------------•---•---=-: -----•--------:----- s e , -•----------------------------------------- -----------------------------------,-------------------------------------------- -----------•-------•---------------- -------- -----------------------•••------------------------------------------ -------------•----------------. ----------------------------- ----------- - ------------------------------------------•------------------ •------------------------- ------------------------- ----------- ------------------------- -------------------tN'`-----------=�-,- -------- ------------------------- ------------------•-"------ ------- �i---�--------- ------- --------------------- FINAL INSPECTION BY: --- ----------------- Date - �• -----------------------•---- I SAN JOAQUIN LOCAL HEALTH-DISTRICT P 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California e ES-9 2M R; ed 8-'59 F.P-Co.