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APPLICATION-FOR SANITATION PERMIT Permit No. ...-1.-?SS.7 f (Complete in Duplicate) This Permit Expires 1Year From Date Issued ,Date Issued ----- Application is hereby made to the San Joaquin Local Health District for a permit to construct and iristall(the work herein described. ; This application is made in compliance with County Ordinance No. 549, JOB ADDRESS ANDOCATION.._:. ._ = ` ----- --- ----- Owner's Name ------- -- ;+. -•-------------------•----=----- ----- Phone Address-- t 9� Contractor's Name------------- •_r-- -----`--- I r I �` ' ��LL -- --- -- t Phone,2k-4 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [I fxMotel ❑ Other ❑ Number of living units: !/-- Number of bedrooms .A- Number of baths _ ___ D Lot size. --- -- �3.�• Water Supply: Public system Community,:system ❑ Private ❑ Depth to Water Table s-a ft.4 Character of soil to a depth of 3 feet: Sand ❑"G^�el ❑ Sandy Loam ❑ Clay Loam E] !Clay ❑+ Adobe Hardpan ❑ Previous Application Made: Yes E] .No [�New,Cons#ruction: Yes ❑ No PR-- FHA/VA: Yes ❑ No ❑ ` s r TYPE OF INSTALLATION AND SPECIFICATIONS: t � • � � (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) e Tank: Distance from nearest well_________________Distance from foundation-------------------"Mater'ia! ________.__-.__-______. No. ofcompartments Size--------- Liquid depth------------- Capacity Distance from nearest well[(•aQeDistance from foundaition___ .10.�_-.-__.Distance to nearest lot line ..... [ Number oflfines___.'�_... __ Length of each line---,3,o-----___-j_-__.Width of trench.____- -- T e of filter material____ ------ Type-� Depth of filter m'aterial-----,A$----------Total length----,3Q. Seepage. Pit: Distance to nearest iwell-(`{� --Distance rom oundation__1-(?_-f...__.i�isfance to nearest lot iine__.S f Numbdr of pits-------! ------------ < < Lig material--- - Size: Diameter!� (v -��.- "Depth-------- --------------------- . .fan, Cesspool: -ID stance from nearest well_______________ Distance from foundation______________----.Lining material__________.___-_____.___ ❑ 1Size:,Nameter:'= -----------------De th-------------------- 1 --------Li Liquid Ca acit als. rt. `•ti I. I -- M p 9 R Y----•----------------- 9 i Privy: Distance from nearest weli_____._-----------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line -------- -------- ---------- •---------------------------------- ( --------------------------------------- Remodeling and/or repairing (describe):----------------------- e --------- --------------•--------- -. - ------------------ - ! , - -----------•-------------------`-------------------- ------------------------------------_---------------------_-----------------______________________ a 11 ____________________________________________________________________________________________________________________________ } I hereby fy that I have prepared this"application and that the work will be�done in accordance with San Joaquin County ordinances, a ws, and rules andrr-eIatians of the San Joaquin Local Health'-Districf, 1 (Signed)------- - - -- ------ -------------------- -- -- ----------------------- ner and/or Contractor) sY:-----------------------------------•-------------1!-----�--- (Title �.. --------------------- (Plot plan, showing size of lot, location of system inrelation to wells, uiidin gs, etc., can be placed on reveEse side). f f . i xfa ! FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY 4 - -- w _ DATE--- = _. REVIEWED BY ------------------------------------------------------------------------ DATE----------- ------------•------------- BUILDING PERMIT ISSUED - � - -.--- - -------------------------- ----------------- DATE------ ---------------- Alterations and/or recommendations:_ I. ___�--`' ___________________ J _� i-- Z 2 - - - ` � - - - ---------- r tP "., ----------____________________--------____---- -----------------_____ _ _______ ______________________________________.____- _ FINAL INSPECTION BY:__! _ Date — 0 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+reef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California J ES-9-2M Revised 8-'54 F.P.Co.