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APPLICATION FOR SANITATION PERMIT Permit No, .................. 3 — ( Duplicate) f� This Permit Expires 1 Year From Date Issued Date Issued 7 ' lets in ' .� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made-in compliance with County Ordinance No. 549. �s 1 _ o r z_� JOB ADDRESS AND LOCATION---- 14 OCATION--- f�1 hone Owners Name -- --- •• ----- _q--- ------- ------------ ------------------------------- ---------------------------- Address------ � '--. �- -�d- a--- Contractor's Name--- 16-6,4-: --- --=- ----- Phone_j4_'-O.S 4'_�.----- r Installation will serve: Residence A a�tm�e-it House Commercial ❑ pi,y �� i ❑ ❑ Trailer Court ❑ Motel ❑ Other � ] I Number of living units: ________ Num er o f edrooms -------- Number of baths ________ Lot size Water Supply: Public system ❑ Communi4, system ❑ Private ® Depth to Water Table --577- ft. Character of soil to a ;depth;of 3"f� t S dnd Gravel ❑ Sandy Loa b4 Clay_ Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ �o i,ew Construction: Yesw No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECFICAt ONS: (No septic +ank or cesspool permifted(fjpublic sewer is available within 200 feet.) Septic Tank: Distance from nearest wel!__,0------Dislance from foundation__0----------.Material__ --r---__---g �- 2 No. of compartme6ts__�_�,t-_..____Size_ _I.6_____________i_.___Liquid clepth______4-!..._______._Capacity_.6-0d.�, Disposal Field:- 4uber Rnce from nearest well__�_P"._Dist nce from foun'dation`s-�.........Distance to nearest lot line_______________•- p 1 of lines-__,I&-!----------------------Lenlgth of each Iine�2XQAa-�x5�'� �rSC/Vidth of trench.__- ,41'!_---- ,------ rJ Type of filter material___j�p-_______Depth of filter matleial-___t_�_1I_____--_Total length--_3_ �_______________________- Seepage Pit: Distance to nearest well----------1-----------Distance from foundation--------------------Distance to nearest lot line--------------- • j ❑ Number of pits------- --------------Lining mateiial--------------------- .Size: Diameter-----------------------Depth--------------------------------- esspool: Distance from foundation____________ ___Lining material__._---________-_______-_--_________ 0 SiA: ameter nearest well ----------.Depth--------------------------------------- 1 ( -----Liquid Capacity--------- -------gals. Privy: Distance from nearestwell____ __ ________________________Lstance from nearest buildin _ 1-� g ❑ Di�tante to nearestllot�e.___,_ Remodeling and/or re airing (describe_______ _________ _____________. -_____-__--_ -------------- ----------------------_--------------- ----------------------------�--------------------------•----- ---------------------- -- -- - ---------------------------- --------------- ! l hereby certify ta+ I have preparl d this application a d that the wor� will be done in accordance with San Joaquin County ordinances, State laws and rules and regulations of the 'San. Joaquin Local Health District. ----- (signed) ---------------------- ------- -- ------------- �er Contractor) l - BY ! Title-------- �- (Plot plan, showing size of lot, location gf syst in gelation o wells, buildinjs, etc., can be placed on reverse side). l' FOR DEPARTMENT,USE;.ONLY APPLICATION ACCEPTED 13Y_---- J-r_- -- -- ---------------------------- ------------------------------------- DATE-----�----Z--�- 4'--�•------ -- --------------- REV IEWED BY_ ----------------- --------------------------------------------------- ----------------------------- DATE BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- ----------------- DATE.----------------------------------- Alterations and/or recommendations:-------- ------------------------------------- --------------------•-• • ---------------- W ----------.$10.---- ---- ,�--------------- -- = S - - --- ----------------------- - ------------- ------------------------------ --------------------------------------- --------------- FINAL INSPECTION BY:--- )7" Date. raj. --779 ------------la l --- -- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-92M Revised 8-'59 F.P.Co. r