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APPLICATION FOR SANITATION PERMIT Permit No. .. �_/___(a•.,1.. (Complete in Duplicate) Date Issued This Permit Expires 1 Year From 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. �$`� - /2Qrpk 1�3° - 1 JOB ADDRESS AND LOCATION/____Y4.��-______________ . ... - `-------------------------- Owner's. Name- ( f-••-•----•-------- ------ Phone--------------------------------- Address------------ ,.i.1 * • ./ Q►'� Contractor's Name---- - ame--- (�' l -f /3 �s _ Phone Installation will serve: Resid� e � Apartment House ❑ Commercial ❑ Trader Court ❑ Motel ❑ Other ❑ Number of living units. Number of bedrooms .Z--- Number of baths f______ Lot size __ _____________________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table SSJ_ ft. Character of soil to a depth of 3 feet: Sand L❑ Gravel [] Sandy Loam 4 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous, Application Made: Yes ❑ No New Construction: Yes 00 No ❑ FHA/VA: Yes ❑ No ❑ -r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) W Septic Tank: Distance from nearest well-��-- __Distanc from foundation__ ---Material__ ______________________________ { No. of compartments______._____________Size__ __ _ _�'__ __Liquid depth-------- Capacity__ - __..___ Dis osai Field: Distance from nearest wel 7� ______Distance from foundation__/0------------Distance to nearest lot line__s------------ Number of lines------- - ----------- -------Length of each line-----/-----------------.Width of trench.-_ -fl'0------------..___---- Type of filter materia Depth of filter material__/f� ----------Total length_.. 'D '-------------------------- 1 Seepage Pit: Distance to nearest we I_______---------------Distance from foundation--------------------Distance to nearest lot line----------------- 0�- ❑ Number of pits----------------------Lining material----------.------------Size: Diameter-----------------------Dept h---------.---_------------------- Cesspool: Distance from 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---------------------------------- --------- - ---------------------- Remodf4ing and/or repairing (describe):-- --------------------------------------------•---------•-•-------------------•-------•------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------•---•-------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an ule and regulations of the San Joaquin Local Health District. (Signed)---,l.-__r •- -- - ------------ -- --------------- --------- ------------------------------------------------------------------- -- --------(Owner and/or Contractor) Ely:----- -------------------------------------------------------------------(Title)------------------ -------- ---.._...-------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ --------------- ------- ------ --------------------------------------------------------- DATE__x'47'-+4- ----------------------------------- REVIEWEDBY------------------------------------ --- ------------------------ --------------------------------------------------------_ DATE-------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations-------------------------------------- ---------------------•-------------------------------------------•---------------•-------•------------------------------- ------- ------------------- ----------- - ------------------------------------ --------------------------------- ------ ------- ---------- - ---- ----------------- ----- ------ ------ ---- ------------- --- ---------- FINAL. INSPECTION BY-------------- ------------------------------------------------- Date- -------- ---------------------------------------------- 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 ES4-241 Revised 8-'59 E.P.Co.