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APPLICATION FOR SANITATION PERMIT Permit No. ._.�./../ _.`1_>�_ (Complete in Duplicate) Date Issued ��1iv13 This Permit Expires 1 Year From Date Issued 1 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 Ordina e No. 544. w l JOB ADDRESS AND 'Owner's Name-------------- - ---- ---.- - - -- ._.-• ----------- -------- --- Owner's ------------ ------------------ Address---------------------------- 2. 1 fi - --------------------------------------- ----=----------------------------------- Contractor's Name--------------------------------- - ---------------------------------------- ------ Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motels❑ Other C] Number of living units: __ __ Number of bedrooms ________ Number of baths _______ Lot size _____ ________- _ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table /7_A ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel .❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made: Yes ❑ No Ej-'—New Construction: Yes pR--I o ❑ FHA/VA: Yes �o ❑ 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__ 2 '[distance from foundation__._- ----_.MateriaL___ ..fr__-___ _______- I No. of compartments__._.�------------- Size_x ___ _ lJ._.___Liquid depth--- Capacity----- Disposal Field: Distance from nearest well____f7r __Distance from foundation-----le9-_ Distance to nearest lot line___ '�__ L� `s Number of lines---------Z------ Length of each line--------Iva-1 of trench.------- --_-. Type of filter mate rial-f_4,X,0Z�Depth of filter material----2kf`_______Total length------'71 �________________________ Seepage Y-if: Distance to nearest well-------- -----------Distance from foundation___ _ ___�.__ pp ,l� y`'_.Distance to nearest lot line___________ Number of pits.----/-____________Lining material----I&Ale_-Size. Diameter-__Jj_`�-------Dept h____�.es�_10 Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material______________.__.____.__-____---._. ❑ 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):------------- r ` �'l�✓ .. ------------------------------------ - 1 ------------------------------------ ----------------------------------------------------------------------------•------------------------------------------•--------- ------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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. ----=--------------------------------------------------------------------------------40wner-end/or Contractor) (Signed)------------------------ - - ----- - By:---------------------••-------------------------------------------------------------------------------------------------------------(Title)------dam -lam-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- --- -------------------------------------------------------------- DATE----- REVIEWEDBY-------------------------------- -------------•------------------- --------------------------------------------------------- DATE------ ---------•----------------J --------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------- ------F-------------- ---------------- ----------------------------------------------•-------------------------------------------------------- --------------------j>/T 17 T,N -�� - r --------` ------ r �t7------------------- ------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- --------------------- -------------------------------------------------------- ------------------------------ -- -- - -- ------------------ ------ ---- - ` ---------- -- --------- ---- - ------ -- ---- --------- FINAL INSPECTION = [J 'C- Date_... - e__ ----`-'--5--- ------ ---- ------------------------- SAN -------- ---------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Straef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California [S-9-2M Revised 6-'59 F.P.Co.