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APPLICATION FOR SANITATION PERMIT -Permit No _.Z.,2 S (Complete in Duplicate) Date Issued _____ /9/ ` This Permit Expires 1 Year From Date Issued �(.. 1223-!S 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. E JOB ADDRESS AND LOCATION__(� Owner's Name--• ------------------------- -- _ - Phone--------------- -------------------- Address ------------•- Address-----------------••-----•••---------------------- __.. le---1-� _ ---------------------------_--------___---- Contractor's Name------------------------------------------------------- --------------------------------•--•------------ _______ Phone---------_---------------------- Installation will serve: Residence ff] Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other E3i, v Number of living units: s --- Number of bedrooms Number of baths -Z__ Lot size _________________________ Water Supply: Public 'system 'E] Community system E] Private F1Depth to Water Table -_Sf+- Character of soil to a depth of 3-feet: Sand ❑- "Gravel ❑ Sandy Loam K Clay Loam ❑. Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 2rNo ❑ FHA/VA: Yes ❑ No ❑ ! t - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'ces'spool permitted if public sewer is available within 200 feet.) r s r` ' ' Nis n cor art eares______ _________il__-_.-__Size- -_ fo�ation_-��_'P°+�Materiaf_____` '4`�'-AC_-_____-__--_-_--_____- Sep® Tank: Distance mpm nearest wel ---- Dista f Liquid depth........--------------Capacity._/ 0'4----- Disposal Field: Distance from nearest well-S*0_ istance from foundatiory__/O istance to nearest lot line___t�__� I J Number of;lines______ ______ __ �-------------------- ----- 3 _ __ 1__ f_ Length of each line_�.��_�_� Width of trench---- �_�_________________ h Type of filer material---_rSi( _Depth of filter material___.-/_!'_____Total length-------/__5_®_ __________________ Seepage Pit: Distance toi nearest-well -___-_-____I-___-____Distance from foundation--------------------Distance to nearest lot line----------------- , ❑ Number ofiEpits_�� ___ :__:-.--Lining material-----------------------Size: Diameter------------------------Depth-------__------------------------ Cesspool: Distance from nearest well------- -__-_-Distance from foundation- -- ------ ----_.Lining ------------------------------------- 1771 Size: Diameter---- -----------------------4'—' De th------------------ --------------------------------Liquid Capacity __gals. Privy: Distance from nearest well____-_-______I--------------------------------.-Distance from nearest building----------------------------------_-____. ❑ Distance to nearest lot line-- '------------------------------------------•--------------------- -------------------------------------------------•-------------------- Remodelingand/or repairing (describe):------ -------•--—- ---•----------------------------------------•---------•-•----------------------------;-------------------•---------------------- ---------------•----•---------------------------- --------------------------------------- ---------------•---- ----------------------------------------------------------------------- --------------------------------- t ' -- -------------------------------------------- -----------------------------------------------------------------------I-------- ------------------------------------------------ ------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------- "-----------------------•------------------------�----------------------(Owner and/or Contractor) BY:-------------------------------------------------- ---------------- ------ -------:-------------------------------------------------(Title)-----------------------;------------------------- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ; i FOR,rDEPARTMENT fSE ONLY, APPLICATION ACCEPTED BY ` f ' "� ATE------- -- �- ------------------------ REVIEWED BY-- DATE ---------------- ------ BUILDING PERMIT ISSUED-------------------------------------- - ".------- ------------------- DATE------ -------------- Alterations and/or recommendations--------------------------------------------:----------------- -------------------------------------------------•--------------•---------------------------- -------------------- ------------------------------------------- --------------------------------------------------------------------------------=---------------------------------------------------------------------------------------------••----•-•--••------------- ' ---------- ----------------------------------------------------------•------•------------------- ------------------------ ------------------------------------------------------- ? ------------------------------ ------------------------- ------ ----------------------------- ---------------------------------------------------- ------------------------------------------------------------------------- --------------------- --•--------------------•--------- ------- --------- -------- ------------------------------------- � � FINAL INSPECTION BY--------- - -- - �- .. ---`-- •' Date r - - ------------�=-- - - ----- - --------- - ----- - --------- - -- - ---- ---- ------------- t SAN JOAQUINLOCAL 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 6-'59 F.P.Co. r �