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SANITATION PERMIT Permit No. APPLICATION FOR SA 1 (Complete in Duplicate) Date Issued ------ i This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to con ruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. --------------------- JOB ------- •-------JOB ADDRESS AND CATION------- -- - ,�---•- Phone---------------------•------------ Owner -------------• Owner's Name Address---------------------- .c� -�� ----------------------•--------- -------------- j "� ` ---- Phone - --�-`�-�•; Contractor's Name------------11��T-1-4 ••-• -- � Installation will serve: Residence Apartment House [I Commercial ❑ Trailer Court E] Motel C] Other ❑ --------------------------- Number of living units- __ ...__ Number of bedrooms -7---Number of baths __�-_ Lot size _..." ---- Water Supply: Public systeg 'Community system El Private Depth to Water Tab t. e . L?f ; Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy oam [3 Clay Loam ❑ Clay ❑ Adobe Hardpan [I ± previous Application Made: Yes ❑ Nox 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.) .- - Materia4..... ...__------------_-------- ptic Distance from nearest well.................Distance from foundation------------ --Capacity-..._....-----------_-- 0rV--9No. of compartments------------------------- Size-------•---------------- ------Liquid depth------------------------ DspBsal F_i )d: Distance from nearest well..................Distance from foundation--------------------Distance to nearest lot lin e...--_.._._-_.__. J�/�J Number of lines- Length of each line..o-- Width of trench. l JJ ------Total length Type of filter material- ---------- -----Depth of filter materia4.__"-.._.-...___- g �— U\ I .Distance to nearest to line_t�]---_--..--._ C Seepage P- Distance to nearest well:.. UO__"..__..Dsstance f om foundation.../ ___•... . `� Number of pits... __ . - Lining ma#erial... : Size: Diameter". __..._ _ Depth__ -------------- / 777 / - --- - - esspool: Distance from nearest well-----------------Distance from foundation __...--.....Lining material--._-----..----__-....__---------... 4 l ----=Depth----------------------- --- -------Liquid Capacity----------------------------gals. ' ❑ Size: Diameter---- ---------- ---------- --- - - ------ --- -- Privy: Distance from nearest well-..____"...__------------------------- - Distance from nearest building---.._----.__----------------------------- F ....--------.-------------- ❑ Distance to nearest lot line------------------ ---'`=--- - ------------------------------------------------------------- -----------•-----"-""-- "............. 1 F ---------••---- ----------------------------------------------------- 'Remodeli and o airin describe :------•--------- -- .p 9 ( ,.. �c 1 �::. - �-- ------ , ,—e - - -- - ---- ------------ - ------ -- --- --- - --- I hereby certify that i have prepared this ication and t the work ill be done in actor ante wi#h San Joaquin County ordinances. State laws rules nd re ions of he San Joaquin Local Heath District. {Ow and/or tor] (Signed).____ (Owner Contrac By:--•---------------------------------------- = �11e) -- -- ---- (Plot plan, showing size of lot, location of system in-rela ' to wells, uildings, etc. c be placed on reverse side). FOR DEPARTMENT USE ONLY �� APPLICATION ACCEPTED BY--- ------ - ------ DATE-------._- '------------- ---- - ---- -------------------------------- REVIEWED BY---------------------------- ------------------------------------------------ D ------------- -------------------------------- D ATE-----------------------------------------------•----------- BUlLDING PERMIT ISSUED--------i--------------------------------------- ----------•-------------- ----------------------•--- DATE----------------------------- ----------------------------- Alterations and/or recommendations:-"-..___- ------------------ ---••----- ---•------- ------------------------------ ----------------------------------------------- - -----•----•----------------------------------------------------•-------------- --- ------ ------------- ------------•--------------- - -- i ------------------------- ------------------------- -- ----- ----- - --- ----- •------ ---- FINAL INSPECTION BY------------- ---- •-+ --- - Date-- ---------- � _ ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 134 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y. ES-9-2M Revised 6-'59 F.P.Co. -