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_ r APPLICATION FOR SANITATION PERMIT Permit No. ._.... (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 install the work here-in described. This application is made in compliance with County Ordinance No. 549. ------------ JOB ADDRESS AND LOCATION----------- Owner's Name-----: --•-4-� .1-- 4--------------- _ _ =_ Phone------------------------------------ Address .h am-----------2 �..= .---------- ----------------- Phone. .......................... - Contractor's Name--:-_:_-__---._-_- _ -►'Lt -�r------------- Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Number of living units: _ __ Number of bedrooms _- _-- Number of baths _-I__ Lot size - -•= --• ��rte' { Water Supply:: Public system ❑ Community system ElPrivate JX Depth to Water Table dobe Hard11 pan C1. Character of soil to a depth of 3 fee Sand F1 Gravel ❑ ,Sandy Loam. Clay Loam; Clay ❑ A ❑ Previous Application Made: Yes ❑ ,No � New Construction: Yes ❑ No FHA/VA: Yes ❑ No ' + r TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if. ublic sewer is available within 200 feet.) _ P.. 1. 1. �---- ----Mate�al_ q4?v Septic Tank: Distance from "e est well,_4!_G?----Distance from foundation-_/ o� No. of compartments Size - -5� Ligwd depth ---- s-9 Capacity Distance from foundation.---/ '-----Distance to nearest lot iine_ ------• Disposal .Field: Distance from nearest well.. -- r ` Number of lines........ -------------- -- - --Length of each line--_----_ , , Wid#h of trench ; ® " Type of filter material----_/ -�'_- --Depth of filter material i--Total length___---.---/_ iF y 1 5eepege Pit: Distance to nearest well_---1 _ -!_-Distance from foundation ____-_.D-4t toDepthst I ot e_ '1C-- '� • �_.-'-.Size: Diameter_ Number of pits----_�-------------Lining material-_ �. :-- Cesspool rDisfiance from nearest well-_:*----__-.._-Distance from foundation----------------_..Lining material------------------------ ; _ _ Depth- --- -- ---------Liquid Capacity ::.Ygals. r __-------_-:;----- ze: S. ❑ - Distance from knearest well-- _--__ -- ----ar Di fance from nearest building------------------------------------- - Privy: ---•------ ------------------------- ----------------•------- ------------ ❑ Distance to nearest lot ine----------------=----- 4 Remas3e1iand/oq repairing (describe):- ---- - ----- ---- - ------------------------ ---------------- ---------------- --------- -------------- 1 ------------•-------------- ,. ----------- -------------------------- --------------------- ------------- _----------------------------------------------- } --------------=-------------------------------•--------------- - -a ui I hereby certify that I'have prepared this application and that the work will be done in accordance with San Joaquin County al Health District. ordinances, S +e laws, and rules and r ula+ions of the San Joaquin Loc (Owner and/or Contractor) s �.- Si neo ------- - --------------- ti ------- By: Via- = "��. (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 -�r�-I�_ DATE------- - - --- ?_C1--------------------- y APPLICATION ACCEPTED BY ------ ----------- DATE------ -------------=-------------•---------------------- - - --------------------------- - � REVIEWED BY-------------------------------------- -------• ------- - - ------- ----------- DATE t BUILDING PERMIT ISSUED------------------=---------------------•--------------•------------------ -------- --- Alterations and/or rec ------------------------------ -- ommendations: ------ -_--- ------•----------- ------------------ 4� _r> ---------------------- ----- ----------------- 49 -- Date----------------- --- - 111 —S FINAL INSPECTION BY:............... --- ------ - --- ------ --------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street 814 North "C" Street 130 South American Street 1 30D West Oak Street Tracy, California Stockton, California k Lodi, California Manteea, California y ES.9 2M Revised 8-'59 F.P.Co.