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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 9 This Permit E'll x1aires i 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------------------ ----��;��:�1��.�__. t�: ---��.�__ ----1��------------•��•��-----� _z _ Owner's Name--------------V_-0,od-bllidy-o----�#Akjty_._------------"--- "----- 1002 Phone._. ------ ---------Address-----•-----------•--------••---------• � . 1 �T Contrar_tor's.Name------ *01� AAp'1�* -------•--------•----••--- Installation will serve: Residence - '��""""""-""- [I Apartment House [] Commercial Q Trailer Court [:) Motel ❑ Other E❑ Number of living units: Number of bedrooms A--- Number of baths ---4--- Lot size _ it Water Supply: Publics stem y ❑ Community system X] Private ❑ Depth to Water Table _--_4f#- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[3C Hardpan ❑ Previous Application Made: Yes ❑ No k) New Construction: Yes © No ❑ FNA/VA; Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS. I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___7l!t,"1![-------.Distance from foundation_ - No. of compartments-----------------------Size--- ft---x--"Q} --------Liquid depth_" --- - Disposal Field: Distance from nearest well---------Xx._.Distance from foundation_ r-----"-----Distance to nearest lot line----- ---- 19 Number of.lines_------2------------------------- Length of each line_-----'lS"�"----------------Width of trench------24--------------------- Type of filter material__,°-eak-----------Depth of filter material__--�,1 .......... length----150---------------------------- - --------- eepage Pit: Distance to nearest welf_-IlIX--------------Distance from foundation___-�.0*.____._.Distance to nearest lot line-��___._-_._ d Number of pits-----2-_--- -----taming material----Ito-O-------.Size. Diameter------------------13lepth----25 ---------.-------- A, Cesspool: Distance from nearest well_________________Distance from foundation--------.-----------Lining material- -------- \ - ---------- ❑ Size: Diameter--------------------------------------Depth-------------------•------- - - ------=---- Privy: Distance from nearest well____ Liquid Capacity ------gals. ____________________ ___--__-______-___---__Distance from nearest building Distance to nearest lot line--------__.______._ -" Remodeling and/or repairing (describe)----------------- ow septic syst � --- -- --------------------------------------------------- ; -------------------------------------------------------------------------------- ordinances, Sfate.laws, and rules and regulations of the San Joaquin Local HeI hereby certify that I have prepared +his application and that the work will be lone in accordance with Sart Joaquin County alth District. (Signed)-------------------- - _- I "sif4 _ -- ------------------------(Owner and/or Contractor) By:----------------------------•----------------- - �em)n--r�e)lafion Title--- - -��'( ) ------ ------------------------ - - (Plot plan, showing size of lot, locati ofsto wells, bu0- ,- etc., can be placed on reverse side). ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------ --------------------------------------- DATE =�_ �p ---------------------------- REVlEWED BY---------------------- - ---------------------- -- .. -------------------------------------- -- DATE BUILDING PERMIT ISSUED------------------------------ 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 ES-9-2N1 Revised 8-'59 F.P,Co.