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f7 l �VAPPLICATION FOR SANITATION PERMIT Permit No. • (Complete in Duplicate) Date Issued This Permit Expires I 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. r This application is made in compliance with County Ordinance No. 549.. JOB ADDRESS AND LOCA ION___.---_.3Z�t ---6,o . ---- 2�`G?�t_ --------------------------------------------------------------------------•--- Owner's Name----------- 40 z• >✓c� - ----------------------------------- - ---------------------------------------- Address--------------------------------- 1Q.B = �tvU�1 Contractor's Name-----------------_Z.. C -` �,(..1-4�--------------•---•-------•----------------------- Installation will serve: Residence Apartment House Commercial ❑ To P ❑ ❑ Trailer Court ❑ Motel ❑ Other r ' Number of living units: __/__ Number of bedrooms _cx�____ Number of baths _-..... Lot size ____..__��4�.__X �_CI__________-_______ Water Supply: Public system H Community system ❑ Private ❑ Depth to Water Table _yft. � Character of soil to a depth of 3 feet: Sap.d!❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ { Previous Application Made: Yes ❑ No 0, -'New Construction: Yes ❑ NoV FHA/VA: Yes ❑ No's TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pti.cr`Ta�k: Distance from nearest well_________________Distance from foundation-------------------Material------------------------------------------------ No. of compartments Size ----------------Liquid depth------------- - --------Capacity--------------- : , Disposal FieY: Distance from nearest well_________________Distance from foundation-------.------------Distance to nearest lot line-_________.______ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench---._______.__..______________..___ V Type of filter material__________-------------------------Depth of filter material-----------------------Total length------------- -------------__ __________ ___ �Distanee m foundation____ lel �� J Seepage Pit: Distance to nearest well___ /I� Q._-___-Distan to nearest lot line__._______.._ Number of pits--------/.__________Lining material . Size: Diameter..113J-_____...___Depth_____-_— --------------- Cesspool: _____________Cesspool: Distance from nearest well-----------------Distance from foundation---_---------------Lining material-------------------------- ------------ Size: ____..__.__._____._____-- _._.__Size: Diameter------ ----------- -------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-------------------------I--------.-------- Distance - -_.Distance to nearest lot line-------------------------------------------------------------------------------------- Remodeling -- - ---------------------------------------------------•--------------------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------ -••----------------•------------------------------------ -------------------------------•---------------------------------------------•--------------------------------------------------------------- ------------------------------------------------------------------------------- -------------------------------------------------------------------------------- ------------------------•----------------------------------------...----------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, Anand regulations of the San Joaquin Local Health District. f , (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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- = ----------------------------------- DATE------- Y d- `` REVIEWED BY----------------------------------------'-----------• --------=----------------------------- ----------------------------- DATE---•----------- k BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------- --- --------------------------- Alterations and/or recommendations------- = -------------------------- --------- ------•---••------------------------------- ---------------- ------------------------------------ --------------•----•-------------------------------------------------------- ------------------------------------------------------------- ------------------•---------------------•----------•------------------•------------ ................ ---------- --------------------/----- FINAL INSPECTION B --_:.___ Date....______. c--__ ---- 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.Co.