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,C/A /--I-r6 y APPLICATION FOR SANITATION PERMIT Permit No. J]...� " (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. JOB ADDRESS AND�LpOCA,�TTIIONN/-- ------= -- --- �� V� �I/ CAI"I � ` --------------------------------------- Owner's Name_-. `1� �X ------- <? 1 --- -- ------ ---------------- Phone------------------------------------ Address--------------------'�� ------ G '11 .... G f Z�1�� Contractor's Name------- ----------- .__-_- 1 � ---------------------------------------------------- ---- -------•--- Phone ••--•-----•---------- Installatioewill serve: Residence ]" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ # Number of living units: _____.Number of bedrooms - Number of baths _/___ Lot size 4 --------------------------------- O Water Supply: Public system ❑;i Community system VrPrivate ❑ Depth to Water Table 3 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam;, Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ®`* New Construction: Yes 93--"No ❑ FHA/VA: Yes P"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 _`__._________Distance from foundation___IP.....__... ------- __--. No. of compartments_:__ -----------___Size--- �_K "-Liquid depth----- ,f.____..-Capacity---- ____. Disposal Field: Distance frorn nearest well.____' __._Distance from foundation.J.-/�-- --Distance to nearest lot �_ Length of each line______ _ . um�of lines----------�-�--------- -- 9 .Q�---- --Z1 - .W�dth of trench----- -------------------- ; A Type of filter material-- �W,,&Depth of filter material___l ___-______.Total length------ -uP-K____-______________ Seepage Pit: Distance to' nearest Well____--..—.________Distance from foundation___/49______.Distance to nearest lot line---_��___________ Number of its_____ --- !` (� p• ___._______Lining material__��lr�___Size: Diameter___,��___._...__.Depth____�_�____� X� �" 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----- ----------------------------------------------------------------------------•------------------------------------•--------------- - ----- 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 Coun#y ordinances, State laws, and rules and regulations of the San Joaquin Local-Health District. y / ----------------------------------------------- -- y (O�rxc anor Contractor) (Signed)- k By------------------------------------------_-------- 2�� 'l/ � ��------------------{Titl`e)-------��-T-!"1�2�-�'-.------------------------ (Plot plan, showing size of lot, locatio sy`iem iri relation to w-lls„buildings, etc., can be placed-6n reverse side). '-FOR DEPARTMENT USE ONLY ---------------------------------_ APPLICATION ACCEPTED BY P --------`--`--=------------- ---------------------------------------- DATE------j-�- 2 � REVIEWEDBY--------------------------------------------- --------------------------------------------- DATE---•- ------- -----•--------�-�--�------_---•-----•-------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE. Alterations and/or recommendations:---- ---------------------------------------------------------------------------------- ------•-•------------------------------- r K ---------_--------o. z----- --------------------------•---------------------.------------------------- 3 ------------------------------_____---------___-------------------- ________________ ____ --- ------------.--------------------------------------------------------------.___---------------------------------- --------------------- FINAL INSPECTI BY:. - ------ --•- Date------- --- ----------------------------------- SAN JOAQUIN LOCAL HEALTH-DISTRICT- 130 South American Street 300 West Oak Street ' ""—.132 Sycamore Streof'••s 814 North "C” Street Stockton, California Lodi, California �i Manteca, California Tracy, California ES-9-2M Revised 8-'59�.P.Co.