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r1" Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued --- 1-_� -- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to con ct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ' [' �j JOB ADDRESS AND LOCA QQ /TION---------�L-1 ,/------ ----------------------------------------- -----------•------------------------- ------ Owner's Name-------•------- ---•------- ------ Phone------------------------------------ Address----------------------- --•--------Address-----•----------------- �r ------•-- Phone--n4.3- ---•- Contractor's Name__• fw. / � I- r ' Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _- -- Number of bedrooms ___`Number of baths ___ Lot size ------ -------------- Water Supply: Public system ❑ ;Community system ❑ PrivateDif_Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan ❑ Previous Application Made: Yesj4,No New Construction: Yes ❑ No I& FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.) 1c Ta Distance from nearest well_________________Distance from foundation--------------------Material-________-------__..____._.___________________- �-�7 No. of compartments--------------------------Size--------------------------------Liquid dept----------- --------------Capacity-----------•--------`- posal Distance from nearest well-45_ ___.._.Distance from foundation__./.----- Distance to nearest lot line_______. 1 _• �j �j Number of lines'_'-/_-_ §__ Length of each line--- of trench___��_ _..__-�_____ Type of filter'materiai ° v_ ___Depth of filter material_____1��-_---_Total length__________________T___'1------------- Seepage Pit: Distance to nearest well---- ---------1____Distance from foundation-------------------.Distance to nearest lot line____-__.________- ❑ Number ofpitrs --------------Lining material-----------------------Size: Diameter----------------------- Depth--------------------------------- Cesspool: Distance from nearest well ______'---------Distance from foundation___________________ Lining material------------------------.------------ ❑ Size: Diameter `- '------Dep ----------------------------- ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well _____-------------------------------------------Distance from nearest-building-------------------------------------- --. ❑ Distance to nearest lot line--__-.____ Remodeling and/or repairing (describe)------------- ------------------- -------------------••-•-------• ti-------------------------------------------------------------- ------------------------------------------------------------------------- --- --------- ---- ---- -- _� . //+ --- C.C.S -/_ _ ----------------------------- ------------------------------------ ---------------------------------------_----------------------------- ----------- -----------------------•------------------------------------ ----- - I hereby certify that I have prepared this application and that the wor will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joa in Lo Health District. ($igned} --------• - ------ --'-�-- \ - ----- ---- -•----�� ------ -- -------- - -- -------------- --- - ----------- —.. Contractor) By:-------------------------------------------......-------------------------- -- ----- ----------------------- - ---------------(Title)------- ------------------------------- -------------- (Plot plan, showing size of lot, location of system in I ion`ta_wells, buildi , etc.,-can be placed on reverse side). FOR DEPARTMENT USE ONLY E APPLICATION ACCEPT:_D BY---- --•- - -- -- ----------------------------------------------------------- DATE---------- --------- -------------- REVIEWEDBY------------------------------------------------------- ---------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED----------------------- ------------------------------------ ------ DATE------------------- Alteratio sand/or recommend tions:__ _ --- -- , �- .L- --- C -�-, rx�G Gtr. '- - �..t;- �'+--------------- �w��--o--•---•----------------------------------- ------------------------ ------ ------------------------------- -------------------------------- ------------------------------------------------------------------------------------------------------------- ------------- --------------------- --------- ------- ----------•--------- -------- ------------------I--------- ---------------- - ----------- --------------------- ------ ------------------------------ FINAL INSPECTION BY. ' - --------------------------------- Date--------------------- �1 a------------------------------ 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.