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APPLICATION FOR.SANITATION PERMIT Permit No. . (Complete in Duplicate) Date Issued ._____I_. ..... . f1 This Permit Expires l Year From Date Issued /- Applicationi"her by 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 A C� L CATION___ _. .' Y_ _._ �/ � � ------------------------- -------------------- Owner's Name t'�'iXs✓ - Address-------------------1/2_v`S ---•--- --- ------------------------------------------------------------------------"----------------------...------------------------ Contractor's Name__ �� ,' =- ---------------•--•`-- ---"-------------------- Phone�___6/9`�..A/140 ---- Installation will serve: Residence 2'--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_ Number of bedrooms _-/--_ Number of baths _/_. Lot;size ----- __ lal✓______________________________ Water Supply: Public system Community system El-,Private ❑ Depth to Water Table.S�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑� Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made. Yes ❑ No New Construction: Yes ❑ No R?`FHANA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I *No septic tank or cesspool permitted if public sewer is available within 200 feet.] nk: Distance from nearest well________________Distance from foundation----------------.--.Material------------------------------.-_-----."-.-..__. i No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity---------------------- ispo Field: Distance from nearest well.................Distance from foundation-------------------.Distance to nearest lot line__-__-_...__..... Number of lines----------------------------------Length of each line-----------------------------.Width of trench--------------:-------------------- 1 Type of filter material-_-_.---"______" _____ Depth of filter material_________________I__--Total length_--_-_"-_."_-"_-..--__------"--_-.--_.-- 41 op Seepage it: Distance to nearesfi ` ell—A14J 1___Distanc om undation_-..?_ ______.Distance to nearest lot line___ _____________ Number of pits- _.L-------------Lining material_ Q _-.-Size: P/......__Depth-_---- .SJ------___-.-_ Diameter-3-3-- Cesspool: Distance from nearest welt-----------------Distance from foundation--------------------Lining material_".--._____."__-_-___-"_-_______-_-_. ❑ Size: Diameter-------------------------------------?Depth----------------------------------------------------Liquid Capacity----------------------------gals. s 9 Privy: Distance from nearest well_____-_______.____-(----------------- _________Distance from nearest building-------------------_-"_______-.-------"--. ❑ Distance to nearest lot line---------------------- ------ ---------------------------------------- -------------------------------------------- ------------------------- Remodeling and/or repairing (describe): '"= = _ _- — ----------------------------------------------------------------- ------------------------------------------------------------------------------------•------------------------•--•------------------------------------ -------------------------- -------------------------------------------------------------------------------- ------------------------------- --- --- -- ---- - - ---- -------- ----------- -- --- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and ules and regulations of the San Joaquin Local Health District. (Signed) - - --------------- caner and/or Contractor) B [Title) r Y•-----------------------•---....- ---- --------- - (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- C� = �� -------------------- DATE---- ------ - - - - - ---------- REVIEWED BY------------------------------------------------------=--------------------------------------------------------------------- DATE--------------------------------------- - - ---------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations-----------------------1�Z-------------------------------------------•---•---------------------------------"----------•------------------------ ----. -- h ` P ti 2 --------- Date- 7` ' ---------- --- ` FINAL INSPECTION $Y: _ - �f� - - .y L SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ 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.