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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Data Issued This Permit Expires 1 Year From Date Issued --- YZ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This aptp . n mad LOC in compliance>th County Ordinance No. 547. �33 OB AD D ATION_ a DR S Phone------------------------------------ -- Owner's arrie --------------- Address_---------------------- ----------- ----------------------------------------------------------------------- b_1 A_":b.� -------------------------------------------------------------------- 1,C ? 7 ---- S1, , x� ----------------------------- _t,v ------------ Contractor's Name --- �. Installation will serve: Residence Apartm4int House El mmercial 0 Trailer Court [I Motel 0 Other 0 Number of living units: ___i?Number of bedrooms Number of baths _�Of SiZO ---- P__]5,... -__CI--!- Water Supply. Public -system El Community system El Private .53' Depth to Water Table -------- ft. Character of soil to a depth of 3 feet.. Sand Er_s�avel 0 Sandy Loart� Clay Loam 0 Clay 0 Adobe 0 Hardpan ❑ Previous Application Made: . "YesE] No New Construction: Yes E] No 1 FHA/VA: Yes [I NoO TYPE OF INSTALLATION AND SPECIFICATIONS; (No septic tank'or cesspool pqrmitte4, if.public sewer is available within 200 feet.) Septic Tank; _3 Distance from nearest weii-40-R ........ Distance from foundation ---- ------- Materiai ---------- -------------------------------------- tO -Y = . I No. of compartme!nfs___'-_P - ----------------- Si,e� ---- � quid clepth__._4e_"� ------------ Capacity --- /),- V__ 9;; Disposal Field.5 Distance from nea"resf Distance from foundation --- /0 ;_.___-.Distance to nearest lot line ------- Nu4mber: of lines --i" ---- Length of each IAI'_. Width of trench------- c;E_'!K . . .............. 5Z -13. 7" Type of.'filter material- %_Depth of filter material-*_I&L.Total length --- CzLre ----- --------------------- Seepage Pit: Distance to nearest we___________________Distance ------------------ Distance from foundation -------------_---- Distance to nearest lot line ----------------- Z 0 Number of pits---------------------- Lining material ----------------------- Size: Diameter------.-----------.---- Depth----.-.------------------.------_ Cesspool: epth--------------------------------- Cesspool: Distance from nearest well-________________ Distance from foundation --------------- -- .1ining material__..__...._. ------________________. Size: Diameter ------ -------------------------------Depth------ ------------------------ ---------------------Liquid Capacity --- ------------------------gals. Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building ------------------------------------------- ElDistance to nearest lot line--- _------------------ --- --------- -------------------------------- -------------- ------------------------------------------------------- I ",_1 Remodeling and/or repairing (clescribe): --- T-10-61 -- -------------- --------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------•--------I------------! ------------ -_ -_ ::- 2-- $19*- --------- ------------------ ---------------------- ----------------------------------- ---------------------------------------- ----- -------------- --------------- ------------------------------------------------ I ------------------------------------------ --------------------------------------------------------------------------------------------- -------------------- I hereby certify that I have pre red 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:-J6a uin' Local Health District. r. --------------------------------- Contractor) (Signed)--- - ------------------ (Title) By: ------------------------------------------------------------------- ----- -- ---- (Plot plan, showing size of lot, location of system in relatio wells, build etc., can be placed on reverse side). 4 ----------------- APPLICATION ACCEPTED BY -------- f.__r _,L - - t; X.- - I---------- — ---------- '- REVIEREVIEWED WED BY ---------------------------------------------------- --------------------------- ------------------------- ------- BUILDING PERMIT ISSUED--------------- ! : ----------------------------------------------- = Alterations'and/or recommendations:_`i-___..--_-. ------------- __- ---. ---- — ----- -- --- ---------------------- ---------- DATE ------------------------------------------------------------ --------- DATE ---------------------------------------------- -------------- ---------------------- ----------------------------------- ----------------- ------------------------------------------------------ ------------------------- --------------------------------------------------------------- ---------------------------------------------------------- --------- I ------------------------------------------ ------------------ ------------------------------------------------------------------------------- ----------- ------------------------------------------------------------------------------- ---------- ------------- ------------ -------------------- ------------------------- ---- -- ------- - --- -------- ! . - - - - -- - -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - __•____.__-. -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ------- - - - - - - - - - -- - - - - - - - - - - - - - - - - - - - - - - - - - . 2P -------------- ------ ----------- FINAL INSPECTION BY:. Date ......... ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street r 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California J ES.9-2m Revised 8-'59 F.P.0O3 .