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4 APPLICATION FOR SANITATION PERMIT Permit No. ..... &. (Complete in Duplicate) This Permit Expires 1 Year From Date issued Date issued ._____-_/_4/G 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__ -----,�O_��--------- a,�,,,___. Owner's Name----- -6 :' 1 Address------------------_-------- ._... �� -------_------------------------------------------------- -- -- ------------ --------------- Zli Contractor's Name ---------GQ }G .- 641_/ -------� . Phone * ,�( C } / Installation will serve: Residence 214, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other p Number of g units:living i ! - _�___ Number of bedrooms __ Number of baths __�-- Lot size --- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobpi—p5—Hardpan p I Previous Application Made: Yes p New Construction: Yes ❑ NoDd_FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is.available. within 200 feet.) is T Distance from nearest well-----------------Distance from foundation-------_------------Material _____-________---_._____.______--___._________. - _No. of compartments______________________ _ ---Size-------------------------------Liquid depth---------------- -----.Capacity-------------- ----- if i D• a! Distance from nearest well©----.-.Distance from foundation_____/15--_-Distance to nearest lot line___, d Number of lines------ °_-_�_ ___Length of each line--------�__P- ______.Width of french-_-___ZZ-0e.1 _--- 0 Type of filter material_ ____ .r_ _ ------Depth of filter material_---/SI-_____.Total length_____________�`p_-e__----------- Seepage Pit: Distance to nearest well----------------------Distance from foundation__________________Distance to nearest lot line----------------- ❑ Number of pits---------------------Lining material----------.------------Size: Diameter---------'=-------.__Depth__.------------------------------ � Cesspool: Distance from nearest well-----------------Distance from foundation_____________ --.Lining material__.._-_-.____-____.__. Size: Diameter Depth---------------------------- -Liquid----------------------- ---------- --------- Capacity gals. -- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___-___--.._______.__.-_---------_------. ❑ Distance to nearest lot line--------------------------------------------------------------- , t Remodeling and/or repairing (describe)_______________ 1 --------------------- --------------------------------------- ----•-- -- ----------------- ------------------------------------------------ ---- -------- ----- ------- - ----- -- -- ------------- ------ ------------------ ------------------- --- I hereby certify that I have prepared this application and.-that the,w rk will be done in accordance with San Joaquin County ordinances, Sta ws d rules and regulations o he San Joaquin Local He?District, 1 t Wrel�af (Signed)-. - Contractor)By:. -------------- -------------- --- - ------------------------------(Title)--- ------------------------------ - - -------------- (Plot plan, showing size of lot, location of systo w s, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY / I APPLICATION ACCEPTED BY-------"t,R. n ---- ---------------------- --------------- •----------------------- DATE---------- _-�b "6 ` REVIEWED BY ----------- DATE-------------- ------ - ------------------------------- BUILDING PERMIT ISSUED--------------- ----------------------------- --I' - DATE Alterations and/or recommendations:-- -----------------•---------------------- - - - ---- ---- - -----------CON c F_Tj-- 72r-----lam Tf�L� -----•-O--et-- 1�I T1 - �a � m1 a._ _ N --- _T -r ----•--------------------_----------------- --- ----------------------------------- -- -- ------------------ -- -34_e-_7'1Z_ --- ------ ---- -- - ----- --- ---------------------------- -------------------------------FINAL INSPECTI BY• 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. } -