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� T ✓ APPLICATION FOR SANITATION PERMIT Permit No. ._/L.,�.�_Z i (Complete in Duplicate) /o . 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 o. 549. /J ll JOB ADDRESS AND ff AT 110 ------ `------------- - --------• ---------------------------------- Owner's Name - --------- - ---- ---------------------- ----- -------- Phone-----•---------•-------------------- Address Contractor's Name--------- --- -------- ------------------------------•------------------•------------- Phone------------•-----------•-•----- Installation will serve: Residence 22--Rpartment House ❑ SCommercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-r._ Number of bedrooms ---L Number of baths _._Z__ Lot size ___ _f/_. __.l----_-- 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 Erqardpan ❑ Previous Application Made: Yes.❑ No ®- -New Construction: Yesto ❑ FHA/VA: Yes W-- No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_1�Q_.__Distance from foundation___`��______-__ Materiai___-- �-�/� _ ______ _ . L ❑�T No• of compartments_.._ :----_____--__Size_: j_X_-P____Liquid depth__ _ �_ Capacityf �_____ i Disposal F d: Distance from nearest .....Distance from founclation___IK -------Distance to nearest lot line_________ Number of lines-------/__._-_______________Length of each line......54�._____-_-_'v___.-_Width of trench--- _________________ Type of filter material__/-./L,f4Depth of filter material_._1__---------Total length--------- __'______________________ See ge Distance to nearest well._._,1�1)_.____Distance fr m foundation_---149_-_-.___Distance to nearest lot line-_ --------- _ Number of pits---- --------------Lining material___ Q i�--Size: Diameter___ -- ------Depth__-- Cesspool: Distance from nearest well_________________Distance from foundation--------------.____.Lining material-------------------------------------- El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-.--------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------_ ❑ Distance to nearest lot line-------- ------------------------------------�---------------�------- Remodeling and/or repairing (describe)----------------- ;2' �Ll�j�-'`[d 's`2 -------------------------------------------------- --------------•-------____---•----------------------------------------------------------------------------•---------------------------- -----1------------------------------------------- ---------------------------------- 0 i ----------------------------------------=------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and -regulations of the San Joaquin Local Health District. (Signed)------------------- �e--- (QwaeP"meVor Contractor) -- ---- --------------------------- ------------------ ---------------------- ------- --- J ----- Title .-------- (Plot plan, showing size of lot, locatio f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- P``}Q�----------- ------------------ ---------------------------------------- DATE------------0_ 0— REVIEWEDBY--------------------------------------------- -------------------------------- DATE------------------------------ - ------------------------ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------ Alterations and/or recommendations:------------------------------- V- --------------•- ---------------------------------------------------------------------------------------------------------- -----------------------------------------P17------r-F_-('Yj9-------- - 019 l_j�_�o--------b� Z "3' ` --------------------------------------- --- ------------------- ------------------------------------------------------------------------------------- •-- -- J ------- a-e�--------------- 1 ------------------------------------------------------------------ ------ - -------------------------- -FINAL INSPECTION BY- - - - - - --------- ----------- Date-- ? -------------------------------------- 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 E8,9-2M Revised 8-'59 F.P.eo.