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�1 APPLICATION FOR SANITATION PERMIT Permit No...../,Z G o . (Complete.in Duplicate) -'/y. • Date Issued ---_�`_____ This Permit Expires i 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 L CATION----------`140----- -------------=�fl i - --------------------------- Owner's Name--------- _._ �? f --- - ----.._._. Phone-------- Address------------- --------------- ----------------------- Contractor's Name..---- n........F'7._. . . ',� - .---------------------------- --•---• -------------- Phone---, Installation will serve: - Residence 1� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I_._ Number of bedrooms -2--fl-umber of baths _/_--. Lot size ____'��_---- ----------------------- Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(-2r Hardpan ❑ Previous Application Made: Yes ❑ No W New Construction: Yes No/� FHA/VA: Yes El No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e ' a0. Distance from nearest well-----------------Distance from foundation---------------------Material-------------------------------------------------- 111 l f` No. of compartments--------------------------Size--------------------------------Liquid depth_-----------_--.---------Capacity___ Dispo ie d: Distance from nearest well-----------------Distance from foundation-------------------_Distance to nearest lot line____-______.__..- i Number of lines-----------------------------------Length of each line------------------------------Width of french.------------- .--------- 'P"�� Type of filter material__________ ___________Depth of filter material---------------------- Total length__-.____.__-_____:____________.______ _ Se a Pit: Distance to nearest well___ -_Distance rom foundation--/�--_________-Distance to nearest lot Number of its------/-------------- material_____ L. Size: Diameter__` Dept _.-_____. p .. p' g ---------- p C ssp ol: Distance from nearest well-----------------Distance from foundation ..._.__.__.______..Lining material___.______________-__.-__._-________ §' ❑ Size: Diameter-------------------------------------Depth- ------------ ------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____.._______________________.__.._-----. [l Distance to nearest lot line ----------------------------------------------------------------- Remodeling and/or repairing (describe: -- _ ------------ ---------I----- -, ------------ _ .�� .----------- = � ---- -��------------------------ 1.r J - -- u� ------------------------------------ -------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ I hereby certify that I haveprepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules ulations of the San Joaquin Local Health District. (Signed) - ' ----------- __.___ and/or Contractor) . - BY:------------------------------------------------------------- •- --------------(Title) - (Plot plan, showing size of lot, location of system in rela+ion to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY 't ''� �. DATE =� --- -�=-�---REVIEWED BY---------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE----------------------------------- i Alterations and/or r commendations ------------------ ------- •---------- -----•------------------------•-------------- -------------- . �° 1- � C - F._.Y ,------------------------------------ ------------------------------- ---------------------------------- --------- ----------- - - - - - - ---------------- _� �-a'--=--- '-- - ------------- ----------------------------------------------------------------==---- FINAL INSPECTION BY:C C = °7 - -------- Date-- i � ----------------------------------------------- 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.