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APPLICATION FOR SANITATION PERMIT Permit No. ---------- 'C' (Complete in Duplicate) Date issued ------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. r� f/� JOB ADDRESS AND LOCATION... - �� --- Owner � ��_�� f`41 � Owner's Name r L __._.___ P_hon_e -_-_-_ -_-_-_-_-_-_-_---_-_-_-_-_-_-_-_-_ ----•---- Address--------------------.__--j- _ Contractor's Name-----�----•---- ------------------------------------------ Phone----------------------- •----•------•-----•-• ------------------- Installation will serve: Residence Apartment House [ICommercial ❑ Trailer Court E] Motel ❑ Other [I ... drooms ., Number of baths 14,Lot size . �`-=--------- Number of living units: __/--- Number of be _ Water Supply. Public system [ICommunity system g3llPriyate E3Depth to Water Table - ft. Character 4f soil to a depth of 3 feet: Sand ❑r Gravel ❑ ,San Y Loam ❑ Clayl Laam [I Clay ❑ Adobe Hardpan E] Previous Application Made: Yes DY No New Cons�Tuc#ioii: Yes No ❑ „ FHA/VA: Yes ❑�"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 4. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic �Tank: Distance from nearest well------._--------Distance from foundation-----Ak�------ _4&---- - G/ Capacity. Z� --.--- Liquid de .th __-- No. of compartments_ -2---------------Size�i- r Disposal Field: Distance from neares weDistance from foundation---Id.(-----�_sDistance to nearest lot line__ _-________ + Length of each line-- 4P------Width�.of trench...__ �!---------------•-- Number of`lines---•-- -- .- 9 - �, ! f�BType of filter material----- of filter material_-_ .._______.__Total le�gth___.__ _._s _p----------------------- Type _ __-------- �--- Seepage Pit: Distance to-nearest well______'._______-Distance from f ndation____ 1441- ____Distance4o,nearest lot line___._________ I Number of pits.....------------Lining material_ __.--.------Size: -Diameter_ -.--- Depth_.. _sl�---------------- \) ,. Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_.Lining material--._..__-._---.______--___--.-_.___. �] Size: Diameter--------------------------------------Depth--------------------- -----------------------------Liquid Capacity-----------------------------gals. _----------------------------------Distance from nearest building___________._.__.___--------------------. Privy: Distance from nearest well------------------ ❑ Distance to neatest lot line--------------------------- ' ------------------------------------------------------------------------------------------ r + ------------------ ---------- Remodeling and/or repairing (de cribey:__.___-.-._ � ------- --t` -----•------------ --------------------------------------------- --------------------------- 1 ---------------------------------------------------------------------------------------- i I -':. --------------------------------------------------------------------- -- ------- - ---.- 1 hereby certify that I have prepared this application and that the work will'be done in accordancefwith San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r�' # '` ' y t � , �..r --(�� or Contractor) (Signed)_ ---- ----- ,�-- f----_- r Y:---------------------------------- (Plot �. plan, showing size of lot, location of s m in relation to wells, buildings, etc., can be placed on reverse side). J FOR DEPARTMENT-USE ONLY APPLICATION ACCEPTED BY--- 4 `� r� DATE 1 1 fl REVIEWED BY �. DATE------------------------------ ---- - ------------------------------- --------------------------------------------- BUILDING PERMIT ISSUED--------------------- - DATE-----..------- ------------- --�--------------• --- Alteratians and/or recommendations:__..__!`]'- . . _.��_�--�------�-'•--�----------------------------------------------------------------------------------------------- 1 --------------------------------------------------- ------------------------------ ----------- ------------------------- ------------------------------- _ _______________________________________________________________________ - -- --------------------------- R 1 FINAL INSPECTION :. - Date ------------------------- -------- ----- --- -------------------------- SAN JOAQUIN LOCAL HEALTH.DISTR+IOT 130 South American Street 30D West Oak Street �,s ` k✓132 Sycsmore1Sfreat 814 North "C" Street Stockton, California Lodi, California ) Manteca, California Tracy, California ES-9-2M Revised 6-'59 F.P.Co.