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C/ APPLICATION FOR SANITATION PERMIT Permit No. ..1 :_ {Complete in Duplicate) f li This Permit Expires 1 Year From DatIssued Date issued Date ?-- c� i � al ,� Application is hereby made to the San Joaquin Local Health District for a permit to consti•uct�and^•-" �'msfal�the work herein descried. This application is made incompliance with County Ordinance No 549: �; , JOB ADDRESS AND ATION------------- , ----------1-= =- . ------- ----------- -- --------- ---- Owner's Name--------------- ----------------------- Phone------------- ----------------------- Address -•--- Address �' '�L_ Con#ractor's Name '� �. Phone .r Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms _Z-- Number of baths __/__ Lot size ___5� X l L/-Q_ Water Supply: Public system Community system [3 Private E] Depth to Water Table .ff'ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑. Clay ❑ AdobeV Hardpan ❑ Previous Application Made:. Yes [I No ❑ New Construction: Yes [❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200-feet.) Sept• ank:�- Distance from nearest well________.___--_Distance from foundation____________________Material -..____.___.___-___--__.___._______.-----.-----, � fdNo. of com artments_____ t # p ----------- Size---------------------------------Liquid depth- Capacity P Y--------- ---- Disposa_,Field: Distance from nearest well Distance from foundation--/6 '� ____-_____.Distance to nearest lot lin��_____•---- 10) Number; of lines_______________ j� p `—"'I Type of filter material___-. ��-rG_.----pe Depth of filter material width of trench.____ _.-______________ Length of each line_____ -__ ^ �� -------Total length > C See Pit: Distance to'nearest well---/S�CIt�j5enDistance from foundation___��___.____.Distance to nearest lot line__-��-- _ f humberl;of pits----------------------Lining material----- , _-$ize: Diameter--- --------_Depth---- �------------------- Cesspool: ----------------- ..� II Cesspool: Distance from nearest well----------------- from foundafiion.__.____...__--- -.Lining material____--------------_____.____. - ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest buildin ' ❑ Distances to nearest lot line--------- --------------- - ---------------------------------------- ------- - -------------- Remodeling and/or repairing [describe]:_-,;: _ � -------- --- ------ - -- ----- - - - -- --- ------ ------ X' 5 --------------------------------------------------------------------------------- ---•------------------------------------------------------------------------------------------------------------I---------------------- I hereby certify that I have prepared this cation and that the work will be done in accordance with San Joaquin County ordinances, State la , nd 'rulqcqnd regulations the San Joaquin Local Health District. (Signed) ---- -- - � ( Contractor) BY: -------------•--.------------------- -- -- --- --------- ----- (Plot (Owner and/or ontra or) plan, showing size of lot, location of system in r ati n to wells, buildings, c. can be placed on reverse side). k �I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED.iBY-- �- - �� ------------------- ------------------------ REVIEWED BY---------------------- ------------------------------------------------------------------------------------------------------ DATE--------- BUILDING PERMIT ISSUED--i--------------•------------------------------------------------------------------------------------ DATE----------- ----------------------------------------- Alterations and/or recommendations_____________________ ------------------•--------------------------------- •------------------------------- h --------- _ ---------------------•----------- ------------------- D - t,�� .-a7 .._.-- ------------ -----•-------------------------------------------------------------------- ----------------------------------------------- --------------------------- ----- --------------------------------- - -- -------- -�------------------------------- ' --------------------------------- C, �---- FINAL INSPECTION BY:.. C=' ' Date........ I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 'c 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California II Lodi, California Manteca, California Tracy, California `� E �E%,9-2M Revised 8-'59 F.P.Co. 4