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APPLICATION FOR SANITATION PERMIT Permit No. ................•..�, (Complete in Duplicate) ��7f0.-_' This Permit Expires 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 Ordinance No. 549. JOB ADDRESS AND LOCATION- I 1 �J -----------=�� ' Owner's Name--•----------- -� C, � ----------- ^ -----•-- �C-r- _.�,�-�'f-��--------- Phone--------- , - Ad�.IN -------------- --------------------------------------------•-•---•-----�------------------ -----------------------------------------------------------•- ContractorsN8e----------------------------- ------ ------•-- ----------------------------------------------------------------------------------- Phone--------------------------••------- Install will sew : esi ce X Apartment House ❑.. Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Numbe�r`�f lit Number orooms nits: f bed __-_'Number of baths __f__ Lot size -___-_.--_z '-.. `--1-- -- ------------ � , Water Supply: Public syste Communi y Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Loam E] Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes ❑ No 0 New Construction: Yes FHA/VA: Yes ❑ No [2 TYPE OF INSTALLATION AND SPECIFICATI (No septic tank or cesspool permitted if se vailable wit ' 200 feet.) Dista r found tion___ �.___ aterial___ --'" ' Septic Tank: Distance from nearest w� /_--- f No. of compartments------ Nze----- X Liquid clep -------- rte---------------Capacity------ a Disposal Field: Distance from nearest well---- _ --.-Di from foun ation...-.3- a_-_--Distance to nearest lot line_---. --_------Lengt f each line. ----------_ Width of trench-----------of lines----------------�,-- -- ------------� t Type of filter material___yy� z�C-..__Depth of filter mat rial__�/ �-`____-----Total length---------______ �'---------------- .___ from fou dati \ Seepage Pit: Distance to nearest well________ ______ Distance _ __�L"'._`.�___.Dislance to nearest lot iine__.___:�-c�.. Number of p:ts---------- -----------Lining mate rial_ry/ ,� -----Si Diameter----- -------f------Deptn--------z,--,�----------------- - Gesspoo{:.� Distance from nearest well-----------------Distance from foun ation._..____.__._---_-.Lining material----_._-.--__._____._-._----------_ L3 ..... Size: Diameter----- ------------------------------Deth_ ----------------- --- -------Liquid Capacity Privy. Distance from nearest well___________________________________________ ____Distance from nearest building------------------------------------------ n .---- -_---------_-__________.._._.___.❑ Distance to nearest lot line--------------------------------- ----- ------------------------- -------------------------------------------------•--------------- �Remod ing and/of_�repairing (describe) �-�r��Y ------ -------------------- ----•---•------------I----------------- •------------------� -------------- '= ---------- -- -- ------------- -------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------- -----------------------------------°- --- ------------------------------------------------•-•---------- ---------------------------------------------------------------------------------------------------- - I hereby certify that I have pr his application d that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reg a1%ntg1 t e n Joaquin Local Health District. (Signed)---�-Zj-4�t -f---�--f-6 --11-- ov------ -----------------------------------------------------------------(Owner and/or Contractor) V By:----------------------------••------------------------------------- --- - --N----- ---------------------------------------------(Title)-------------------------------------- ----------- (Plot - - - ----(Plot plan, showing size of lot, location of system in relation wells can be placed on reverse side). FOR DEPARTMENT USE ONL APPLiCAT10N ACCEPTED BY �� - ------------------ DATE l REVIEWEDBY-------------------------- ---------- ------ ---------------------------------------------------------- ------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------- ---------------------------------------------------------------- --------- DATE------------------------------------------------------------- ---Iterations and/or recommendations------ --------------------- --------------------------------------------- -------------------•-•----------•-------------------------------------------------- A --- --- ------------ - M -- r Wiz_ h� - - ------------ ... t -------------- FINAL INSPECTION BY: --- ----- Date------------------------------- ------------------------------------------------ SAN JOAQUIN LDCAL A'EA PT bISTRICT i 130 South American Street 300 West Oak Sfroot 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M Revised 8-'59 F.P.Co.