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x0 APPLICATION FOR SANITATION PERMIT Permit No. . ..�. (Complete in Duplicate) q This Permit Expires 1 Year From Date Issued Date Issued __/.4.______:_ 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. p_S 4 ---------------------------------------------------------------------•------------ JOB ADDRESS AND LOC TION... _ �� Owner's Name---------- -� Phone-------------------------------- Address------ = - ,--•----------•------------------------- = f� Phone --•--------•---------- Contractor's Name--•-----------•--1 -•----------------------=--------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _-- Number of bedrooms -_j_.- Number of baths _a _ Lot size ___ "/' ----'�-------------------------- Water Supply: Public system .Community system ❑ Private [I Depth to Water Table x ft. Character of soil to a depth of 3 feet: Sand E] Gravel [3 Sandy Loam E] Clay Loam E] Clay E] Adobe Hardpan ❑ Previous Application Made: Yes ❑, No gR" 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.) i Septic3ank: Distance from nearest well-----------------Distance from foundation---------------------Material-_.---------_--.--._---_______---_--_.----....... x.r 5r/li! No. of compartment------ --------------•-Size--------------------------------Liquid depth-------------4 Capacity----------------------- Disposal Field: Distance from nearest well ---.""_�-_.Distance from foundation-----Z19-_--____.Distance to nearest lot line10 _��_�_______ Length of each line-----_ f a' 1_0x�gi h� Number of lines �- �� Width-of trench.-- ' f------------------ 4- a ° Type of filter materialt��c.,XOK—ADepth of,filter material-___.1T. ------- length_-- __________________---_-_.-. Seepage Pit: Distance to nearest well — --------Distance fr m fou dation_---A --._.Dista Distance to nearest lot line__`�r------ Number --_- o\ Number of-pits-: _ ------------- material_��'&�.Size: Diameter._.tYI�f------ ---De 6____%2------------------- Cesspool: Distance nearest well .___.__Distance from foundation_ __________------ Lining material------------._._.___._________-______ I . Y ---------------• Liquid Capacity- --------------------------gal5'. Size: Diameter Depth Privy: well . .• Distance from nearest well_ --_-_______----------------_____.___.-Distance from nearest buildin ----- Distance to nearest lot line.-._:__'' '--- i Remode J ling and/or repairing [describe) ---------------' a'u-6 - < y ---------------------------------------------------------------------------------------------------------••--------------------------- = - ------------------ ----------- ------------------•------------------ --------------------------------------------•--•-------------------------------------------- --------------. ------ -------------'-------------------= ---------------------- -- r - F'' I hereby certify that I have prepared this application and that the work will be done in-accordance with San Joaquin County C" ordinances,'State laws, and rules and regulations of +he-San Joaquin Local Health District. , (Signed)------- ! ------ --,- - -- ----- --- {�r Contractor] L�'�6 , Tale By:-------------------------------•-------------------------- �2 { )`k ---... urs', (Plot plan, showing size of lot, location of sysf in'relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT.USE ONLY APPLICATION ACCEPTED BY-------- ---- -- - _- ----- ----- DATE,----- ��"' J� -, -------------- r-FP; t `--EVIEWED BY------------------------•-------------------- -:--I--"" - -------- •---------------------------------------- DATE- ' BUILDINGPERMIT ISSUED------------------------------ ---------- -------- -v----------------------- ------------------ DATE- -Alterations and/or recommendations:'__-__ v ---------------- --------------- ------------- - - - - - - ----- - ep + '�b -''_!!i ! V'�r---.._._• ---- ---- - -- -- ------- ..---_----.-------�r------------ ------- _ _.---------- ' ------------------------------- `--------------- ----- '---------- ,� ' ----------------------- --------------------- ---------- - C° - --------------------------- --------------------------- --------------- ----------------------- ----------------- ..... l r y IZ ---��_-_---- 'FINAL .INSPECTION BY------- ---- --------------- --------------------- - Date-------------------- - : ---- - ----------------------------- SAN - ---------=---------------- SAN JOAQUIN LOCAL HEALTH,DISTRICT ' s ` 130 South American Street 300 West Oak Street ' SStreet 814 North "C" Street Stockton, California - `y Lodi, California ')Manteca,camor®Cilifornia Tracy, California t _ ES-9-2M Revised 8-'59 F.P.Co.