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APPLICATION FOR SANITATION PERMIT Permit No. __l{.).. ........... . (Complete in Duplicate) oilil This Permit Expires 1 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 LCATION__ _ � -l± �-4_494 1 ,�,� Owner's Name -•--- ----•----•--- -------•---------------------- --------------------------------------------- Phi56Le 0—T-1--------------- Address ?r-(�_ ------- -- ----------------------------------------------------------------------------------------------------- Contractor's Name-------- Com- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms -------- Number of baths ________ Lot size Water Supply: Public system ❑ Community system ❑ Private❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy,Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes F1-19q..O_ New Construction a Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATIOWAND SPECIFICATIONS (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Mate`ial................................................ . ❑ No. of;compartments--------------------------Size_----------------------------Liquid depth--------------- = ..Capacity------ ---------------- Disposal Field: Distance from nearest well_________________Distance from foundation----r --Y-Distance-to•n'daregt lot line___________._____ ❑ Number of lines-----------------------------------Length of each line------1-------------- -------.Width of trench ------------------------------ Type of filter material____.__ _ _ _ Depth of filter materia----.---------------___Total lengfh--------.__________________________ Seepage t: Distance too nearest w II_ ___.__-_u.__-_____Di.stance fr m foun tion______10________Distance to nearest lot line____: -_____._ Number of pits______________________Lining material_- '-d_ .Size: Diameter__ i; .. -. Depth-, Distance from nearest well-----------------Distance from founda4ion_..__.__.._.-____.Lining material------------------------------------- 0 Size: Diameter--------------------------------------Depth-----------_---- - Liquid Capacity ------------------ q ....------------------------gals. Privy: Disfance:from nearest well_______________________ ___________________I __Distance from nearest building------------------------------------- � ❑ Distanc'e' 'to nearest lot line---------------------------------- -- --------------------------------•----------------- -- Remodeling and/or repairin'p (describe):................................. -- ---------•-------- ------ --------------•----------------•---•--------------- --------------------------------------- --------------------------------------------------------------•----------------•-------------• ------------------------------------------------------•------------------ --------------------•--- --•---------------....--------------------------------------=-------------------------=-------------------------------------------------------------- , hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County TM ordinances, State laws, and gales and regulations of the San Joaquin Local Health Dis+rict.l (Signed)__________________ ______ 4----------- _-------(Owner and/or Contractor) BY: l {Tiff e)-------------------------------------- ------- --------.-------- = -- ----- - ----------------- ---------------------------------------- (Plot plan, snowing size of lost, location of system in relation to wells, buildings, etc., can be placed on revdrse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----------- DATE ----- -- -- --------•--- REVIEWED BY----------------------------------- ------------------------------ ------------------------- ...r - '--- .•` DATE-------- - BUILDING PERMIT ISSUED - - DATE r Alterations and/or-recommendations:_---------------------------------------------------------------------------------------- /---- hj ------- } - ----- ------------••--••-•--------• --------•----- ----------- ------------------------------------ �. ----------- -----------------------------------• r FINAL INSPECTION BY:------ --- --------------- ---------------------- Date----------- �_n. � . 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.