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7!f` kl] APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) This Permit Expires ] Year From Date Issued Date Issued rr--.laO Application is hereby made to the San Joaquin Local Health District for.a permit to construct andlinst'all t e work herem0clesc�ribed. This application is made in compliance with County Ordinance No. 549. A/ _ :. . JOB ADDRESS A LOC ION Owner's me-------• -------------- ---` ' "� -- ---- ------------- --------------- Phone--.------ Address__ `_L ,�- } -_ ---------- ----- _ Contractor's Name------ e_I-,-._ ._ Phone Installation will serve: Residence (� Apartment House E] Commercial#fFrailer Court E] Motel ElOther E] Number of living units: - Number of bedrooms—Number of baths -------- Lot size Water Supply: Public system [❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Ej Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ It No [] ,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.) ( 4 6r,—fo c___�Distance from nearest well-----------------Distance from foundation__.___._____.--___.Material------ L,,, .-__-_____.______._____.______-_._._..__. 1 1�� No. of compart vents--------------------------Size--------------------------------Liquid depth---------------- ---------Capacity---------- s Distance from nearest wefl_�'I4P{ Distance from foundation---]P_r---------Distance to nearest lot j� Number of lines__�__--�_____________ _____ ____ j� �I - - - - Length of each line-----��? �---------- --�Width of trench-..�.f:'�------------ --- 3 -5Gt Type of filter material--$__ J�S_____Depth of filter material------j_. `'_=.Total length g c --------------- Seepage Pit: Distance to nearest well----------------------Dis#ance from foundation-------------.----- Distance to nearest lot line----------------- F1 Number of pi#s--- ------------------Lining material---------_----------...Size: Diameter------------ I ----Dep#h--------------------------------- Cesspool: ---------------------- -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 nearel t lot line----------------- ----- Remodeling and/or repairing (clescrllje):-____4/----- --�fe- I------ - --------------------------------------- - - ----------------------------------- -------------------------------------------------------------------------------------------------- ---•-------•---------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and fhat the work will be done in accordance with San Joaquin Counfy ordinances, State ws, And rules and regulati s of San Joaquin Loca ealth District. t (Signed) . �x r._ --- --------------•-------------------(Owner and/or Contracfor) $y:. ----------------- ---------------------------------------- --- ----- ------ ---- / /__. (Tale)------------------------------------------------ Pot plan, showing size of lot, location of system in relafion to we buildings, etc., can be placed on reverse side). l FOR DEPART ENT 115E ONLY APPLICATION ACCEPTED BY--------------------------- ----------------------------------- DATE------ - - REVIEWED BY------------------ ` — ---------- ----------- --------------- ----- ------ DATE_ -------------------------------------------- -- UILDING PERMIT ISSUED-------------------------------------------------------------- ------------------------------------- DATE- -------------------------------------- ----------------------------- Alterations and/or recommendations ------------------------------- ---------------------------------k------------- ------------------------------------ FINAL INSPECTI • ��- - ----- --- -- - ---- ------- Date----- �_L-__-�/_.`.`U`1------- ---------- - ------------ -� 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.CD.