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APPLICATION FOR SANITATION PERMIT ' . Permit No. .//, (Complete in Duplicate) Date Issued _AO/ 4 This Permit Expires l Year From Date Issued Application is hereby made fo 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 Ordce No 49. ti ' 1 h C___Z �r JOB'ADDRESS AN Jl�TION---------1------�.____E--------- -------x----- i'�-- ---------- --------------------------------------- 0 -ner's Name I� { K ---•-•-• +---"- f -------- ---------- -"- Phone-------------------------------- w ��,` ` 1-=-----Ti - --�---�---------------------------------------------------------- Contractor's Name--=--•- ---��i�( _ �"�� Phone-------•-------------•--•---------- Installation�will serve: Residence�Apartment House ❑ Commercial ❑ Trailer Court ❑ My�ote�l ❑� O her ❑ i , - Number of living unitsl�: __- -__ Number of bedrooms-_ Number of•baths __-!___ Lot size ____ �--- --------- p Water Supply: Public syste��l ❑ Community,system ❑ Private K^ r Depth to Water Table _::_ _ ft. Character of soil to a depthlof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made:i Yes ❑ No [ New Construction: Yes jK No ❑ w FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septi A or cesspool permitted if public-sewer is available within 200 fetr } _�_- - __ S pId — nk 61 Distancefrom nearest welt:`_ __-_.Distance afro ioun I,on________ __Ma# nal NX t No. of-com artments ------------- ---Size-----X _? Liquid depth - -- ------- Capacity •, p ; u�l -_- 10 to to nearest lot `ine----t+ ______ Dispo al4ield::. Distance from nearest well______Distance from foundatiou.�Numberof lines___.___`__ t_ � Length of each line__________("_ (A______-_.Width of trench__ _.- __�}} t .,,_Type of filter material--- 1.'�]apth of filter material____�g________ Total length _____________________-- Seepage Pit: Distancelto nearest well______________________Distance from foundation____-_-______..___.Distance to nearest lot line__"_____-_______- i ❑ Number�1of pits------ ---------------Lining material----------------------Size: Diameter------------ Depth "J Cesspool: Distance) from nearest well______-"---------Distance from foundation______________.__..Lining material___-__-___-___"___-___"________--___. . ----gals. ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity-------------------- Privy:*•-4 "�— - -Distancfrom nearest well-------------------------------------------------Distance from,nearest building-------- ----- ❑ Distance to nearest lot line--------- -------------------- ---------------..----- -------------------------------------------------------------------- `_ Remodelling and/or repairing (describe)=-------------- -------------- - -----------------------•----------------------------------------------------- �l)' - �. i -----------------------------------------------I it-------------------------------------•-----------------------•----------------------------------------------------------------------------------------------------------- I hereby.certify that Ihave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I rules and regulations of the San Joaquin Local Health District. t �( (Owner and/or Contractor) {Signed - -- ------------ ------------------------------------------------- --- - r , r Tale BY: = -------------- - ---------------- ---------------------------------------------- (Title) (Plot plan,.showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �u F ° FOR DEPARTMENT USE ONLY ,ip APPLICATION ACCEPTED BY------------------- - -- ------------ ------- ----------------•------------ -------- DATE------ ---f-------- ------------------------------ REVIEWEDBY--: -----------41-------------- -------------------------------------- DATE------ --------------------------------------------- BUILDINGPERMIT ISSUED---------------------- •---- --------------------------w--------------------------------- DATE Alterations and/or mml ndations:;--------- -------------------------------- - --------•-------------------•--------------------•----------------------------- --------------------------•------ �ll ----- ----- ----- /fc la.J 3 ----- -------------- ,Il - .. --- - ------------- ----------------- ----------- ---- ---- - ------------------ - .__ .r-�_._ : - ---------- -- - -----S-014.------- ---- Date-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street Y Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.Co. illi