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APPLICATION FOR SANITATION PERMIT Permit No. _11711F ".117f1 (Complete in Duplicate) Date Issued .____/ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta the work herein described. This application is made in compliance with County Ordinance No. 549. X 7 3 �- JOB ADDRESS AND LOCATION----- 1 ___ -_ ----- -- an ------------------'---'--: - !; } . Owner's Name------- _ -----------------------•-••-------•-"----------- - -- ---------------- Phone ' ' Address------------------------•--.------------------------------------------------------------------------------------------- --------------------------------------- ----------------------------------------------- Contractor's Name--- --•-•---- 0-t-4 :-. _`-610A. ": � -it--- aa4`ifI Phone i Installation will serve: Residence [I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . Number of living units: _^ __', Number of bedrooms _'°____ Number of baths ______ Lot size -------------t ___ _�s_#--------------- :* -------- -------•---------- i Water Supply: Public system ❑ Community system 4] Private ❑ Depth to Water Table _46- ft. ' Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam E] Clay ❑ Adobe' ] Hardpan El Previous Application Made: Yes ❑ Not New Construction: Yes ] No ❑ PHA/VA: Yes X] 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---- ______-_Distance from foundation" _!'__----____M e ial CCIt-T-1* ------------------- No. ---___"...........No. of compartments--_- ---------- Size .. -- ------------Liquid depth "- -------------- Capacity.. ;--------- Disposal Field: Distance from nearest wellx "_"__-Distance from foundation 0 Distance to nearest to line- s- ANumber of lines__:-:____ --Length of each line--,___ Width of-trench '14---------------------------- e ____ -__"_ """_"-_"_ '. Type of filter materi _.. ' ""Depth of filter matea-1_40 ".__.__.Total length__. _________ ___ _�____._.__ t nc to nearest well------ Distance from foundation____ _ ___..____Distance to nearest lot line__.__' Seepage Pit: Dis a e � ,�-"f-*-•--•- Number of pits---" __..__.._.___Lining material___ _____..Size: Diameter_-____'__ ----_Depth_..A .---_t -------- 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)_-------- o€ ----------------------------------------------------------------------•--------------------------------------------------------------------------------------------------------------------------------------- --------------- 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. - _ 1 , ._: ss --------------------- ( / 1 (Signed)-------------------1 -- = Owner and/or Contractor --------------------------------------------(Title)---- " ------------------- ------------- - -- - (Plot plan, showing size of lot, location ystern in relation to wells, buildings, etc., can be placed on reverse side). �-� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - - - - - --------- ---------------------------------------- DATE--- r'---------6---,---------------------------- REVIEWEDBY---- --------------------------- -------------- -------------------------------•---------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------- -------------- ----------------------------------------------------------------•-••---------••------------------------------------------------- ------------------------------------ --- -----•--- ---------------------- ---------------------------------------------------------------------------------------•--------------------------------------------------------- ----------------------------------•-------- -------- �-7 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 ES-9-2M Revised 8-'59 F.P.Co.