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APPLICATION FOR SANITATION PERMIT Permit No. ._.f (Complete 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 Or ante No. 5 t. JOB ADDRESS A CAN-___ -�- - �, l --------------------------------------------- Owner's Name_-_____ __ _ _ ,--,�- _ -- --• l: x ..._ ------ Phone Address___-_____ --- -- •---------------V- --------•----------•-••-----------------------P--hon- ��e7--- Contractor's Name---------= _ - - --- ------------------------ ------- -------- ------ e - -��--' , • I� Installation will serve: Residence [Apartment House E] Commercial ElTrailer-Court,❑ Motel,❑ Other ❑ Number of living units: __ _ Number of bedrooms ._�-J. Number of baths _ Lot size -------------•------••------- `. Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table -IN ft. AIN Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Cla Loam Clay Y ❑ Y ❑ y ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction; lyes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ank: Distance from nearest well-________________Distance from foundation----------------._-_Material No. of compartments ------Size------------------------•-------Liquid clepth--------------------------Capacity-----------•-------- J osa i Distance from nearest well_________________Distance from foundation--------------------Dista nce to nearest lot line----------------- Number of lines---•-------------------------------Length of each line------------------------------Width of trench.---------------•------_---- ------ Type of fitter material--.,;.,.-,.,;--------------Depth of filter material-----------------------Total length_____-___________:_____-__---__------•-•.- WW1 Seepa it: Distance to nearest wel ---Distant r f ndation_!- __.*_ ' ___ Distan�y to nearest lot line____S___..--__ Number of pits_ ,f Lining material, ` :"''--.Size: Dia meter._. t3..._ --- --.Depth-- -c�.5--�-------------- Cesspool: Distance fiam nearest well____.__-_.!___Distance from foundation______-------------_Lining material_______-._.___.__.___---_ ❑ Size: Diameter--------------------------------------Depth------------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------- from nearest building--------------------------------- ❑ Distance to nearest lot line----------------------------------------- ----- { Remodeling and/or repairing (describe)__________________________ _ " -------------------------- _______________________________________________________________________________________________________________________________ ------------------------------------------------_______-----------I----------------- ___________________________________________________________________________________________________________________________________________________________________________________________________________________ I hereby certify' I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State�aws, nd rules`a regulations of the San Joaquin Local-Health District. (Signed) ----------- - j Owner and/or Contractor) BY4� -`'-- ---�---------------- ----------{Title)---------- ----r---------- - --------- - ----- -------------- (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). ----------------------------------- + ; ; FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - - ------------------ ----- ---------------------------------- z l --------------- -------- DATE----------lEWED BY---------------------------------- ------------------------------- ----------------------- ------------ .- DATE----- - -------------•-- - ----------------------- UILDING PERMIT ISSUED-------------------------------------------------- ------ ------------ - -- —------------------------------------- DATE------------- " Alterations and/or recommendations:------------------ ---------------I t� ----- - -- = ---------------------------------------- --� --- _ . - . ' :--___-� --------- ----------- --------------•------------ FINAL INSPECTION -------------------------- 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 6-'59 F.P,Ca.