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APPLICATION FOR SANITATION PERMIT Permit No. -Z!._.L-LQ�_ (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.-1.9-compliance with County Ordinance No. 549. ./ '� .. - --------------------------------- OB ADDRESS AND LOCATION__ .--- --------!%'lr --.-•-�G� -------- ------------------- Owner's Name > -----------------•-•----- --- ;---- ---------._. Phone Addressx - Contractor's Name------ 1141%44 ---------------------------------------------------------------------------------------------------------- Phone----------------------------------- i�j Installation will serve: Residence `T' Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms -)---- Number of baths .1----- Lot size -�r /AV _________________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 47r ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loarnt Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No Z New Construction: Yes ❑ No 9� FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__J_.P-=1 t____Distance from fou dation_/P------------Material _�-------__________________________________ ANo. of compartments---.l--------------------Size---,5 --?!!- ------Liquid depth---- ---------Capacity--e ---------- W Disposal Field: Distance from nearestwell6-p_-__._Distance from foundation__Zp---___o.Distance to nearest lot line---S________ ❑ Number of lines_______ __ __________________Length of each line_/_ �!'_ _-:i'_-_'Width of trench_-___--__ Type of filter materia Depth of filter material___14rf-----------Total length--- See .Ege ength___Seepage Pit: Distance to nearest we(____________________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-----------•-------------------------------------•-------------------------------------------------------------------------------------------- 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, S to laws, anVrs regulations of the San Joaquin Local Health District. Signed______ �___ _ Owner and or Contractor-- ----- -------------------------------------------- E3Y--- ----•-- ----•--•-•---•----•-------------•--•- -------------- ----------------------------------------------------------------(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_4'�Gv REVIEWEDBY------------------------------------------------------------------ ------------------------------------------- DATE------------- ---------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DA•TE------------------------------------------------ Alterations and/or recommendations:-------------- --- ----------------------------------------------------------------------------------------------------------------------------- ------- -------•------------------------------ ----------------------------------------------------------•----------------------------------•---------------------------------------------------------------------------------------- FINAL INSPECTION BY.,,/-/t % -----------------•---------------- 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 ES-9-2M Revised 8-'59 F,P,Cc. s