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( APPLICATION 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. ' "This application,is made in compliance with County Ordinance No. 549. Q Q �--- JOB ADDRESS AND L CATION-----��--�- --'-�----•l -- -�-------/1••�-------� ..tl.------ - ��'------•---------------•------• •---- Owner's Name--------- -Z111P f`...........L,.,%/o -•-- ----------- Phone.---•----•-•..................... Add Contractor's � ./ ••........ p`c�'r* 1_�.-._'.. �� -------------------------------------------- Name-- _ _ _ ------V_ _ •---- _ qx --- Phana 1, _4 Installs#ion will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel p Other ❑ Number of livingunits: __� umber of bedrooms ?-----Lot size _,f�7C�_, .-_ -�c�__---------------------- Installation _________________ ,�.�_ Number of baths �._. Wafer Supply: Public system 9 Community system Private E] �0 Depth to Water Table __ ft. Character of soil to a depth of 3 feet:!Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe Hardpan C]Previous Application Made: Yes ❑ No� New Construction: Yes [:] NoFHA/VA: Yes E] No El \ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) epti T Distance from nearest well_________________Distance from_foundation-------------------Material-----__._______.._.______-...___.__...___-_____. l No. of compartments-------------- _ ___Size---------------------------; . Liquid de th_____________________ Capacity... _. r r Q Dis al Field: Distance from nearest/well. ��__ Distance from foundation _/V _______.Distance to nearest lot Number of lines'_='___1-_.......... _:___ -_ . Length of each line_______ .________.Width of trench_.•Z<l�X 11 !.y f. �r; :.: . ._g ,.. -- -------------- Type of filter material_". GDepth of filter material---'/ ---------------- ----------- Cx Type length___.____a---__________________________ p g Distance from foundation--------------------Distance to nearest lot line--..---..___.--.. 5eeg� Pit: Distance to nearest.well_.',._____-._--_-_� . Number of its-------�_----_ __u_.Linin material'____------------E.....Size: Diameter---------.-------------Depth-----------------------------•_-- Cesspool: Distance from nearest well_______!--------Distance from foundation______________..__.Lining material------_____________________.______-_. l ❑ Size: Diameter --1------------`.-------- �- Depth- ---=---------„ ----------------------------- Liquid Capacity gals. Privy: Distance from nearest well-______`______e___.--______ti__,t_---- Vy__r_-Distance from nearest building____-__._________________________________ ❑ ~'4 ------------------------------------------------------.-_.____._..-__. Distance to nearest lot line—�_-:____, •--°...w�, Remodelin and/or repairing describe :- _-- a� - ----••----- -------------• g / p g I -"-•-•- - •--------------------- --------------'_ _ _ -- - ---'3----'-- ------ -----__-- -- - ------------------------------------ ----- _ ' -- } i -_ 1 i ------------------------------------------------------------------------------------------•---------------------------------------------------------------•----------------------------------------------------------------- I hereby certify thahave prepared this application and that the work will bed in accordance with San Joaquin County ordinances, State law , an rules and regulations of the San 46aqyjn Local Health Eflsmcf. �-- ___.'__ Owner and/or Contractor (Signed)---------- ----- --------- { / l ------ --- -- gY: -------- ------- ------------------t---------- - ----- -�- --- - -------- -- ----(Ti+le) (Plot plan, showing size of lot, location of system i relation to wells, building +c., can be placed on reverse side). FOR DEPARTMENT U ONLY l APPLICATION ACCEPTED BY-- rCN_'_2 -----•------•--------------------- DATE--- REVIEWEDBY------------------------------------------------------------------------ - DATE---._.....--------------- BUILDING PERMIT ISSUED------------------- -------------------------------------------- ------------------- ----------------. DATE-----------------------------------------------------------•- Alterations and/or recommendations-------------------------------------------------------------------------------------------------------------------------------------------- ------------------- ' -------------------------------- --------------------•-------------•----------------------•-------------------------------------------------------------------------------------------------------------------------- -•-----•----------------------------------------- •-- ------ -----------------------------------------------------------------•-------------------------------------------------------------------•--------------- ---------------=---------------------- ------------------•--- ----------------------------------------------------------------------------------- •-•-------------•---•-----------•----------- ------------ ------------- --------------------------------------------------------------------•----^--------------------------------------•----------------------------------------- -------- - -------- --------------- -------------------------•--- J eo FINAL INSPECTION BY:. ---- -.•., -------------------------- Date------- _' -j-- SAN JOAQUIN LOCAL HEALTH DISTRICT 00 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9 2M Revised 8-'59 F.F.Co.