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j APPLICATION FOR SANITATION PERMIT_.. Permit No, .... .. � 4 1 �. (Complete in Duplicate) �f yf This Permit Expires 1 Year From Date Issued Date Issued __- Iq�^Z��'t8 ` 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. I I JOB ADDRESS AND LOC TION 1 X17f6 �� f -- ------ Owner's Name ` - - ----- ---- ----------------------- '--------------- -------------------------'---- ----- --- Phone �r Address ----45�� t--- --- �/ ------------------------------------------••---= ;e ^. .' Contractor's Name. .. 14 -L- ` _ -----------t --------------- Phone �_... Installation will serve: Residence Apartment House ❑ Comm{ercial-E'] Trailer CouIrt ❑ Motel 0 Other ❑ Number of living units: _. _ Number of bedrooms J__ Number of baths _- __ Lot size --_ ----------------_-_-_ Water Supply: Public system 0 Community system ❑ Private Depth fo„Water Table 14- ft1 Character of soil to a depth of 3 feet: Sand B---G-ravel ❑ Sandy Loam ❑'-day Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: ;Yes ❑ No [13--New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest well-5-Q_!_-Distance from I foundation -o�u_n._dation- _/S ---------Material-j___ -------------- No. _ r . of compartments--.____ Size____,"___ ---Liquid depth--- �`- ---------..Capacity_-.-_- .t4 ---- Disposal Field: Distance from nearest well._.._ Distance from ation.._/---------Distance to nearest lot Number of lines---------- `r �._.____ __ Length of each line-__9a_____.�'_O_-- ._.Width of trench-..__..�-�---------__-_.--- t Type of Pilfer material__. 'r.-. t _Depth of filter material___ 8_`_.__..._Total length-_-_ �--------------------------- Seepage Pit: Distance to nearest-well---------------------Distance from foundation--------------------Distance to nearest lot line----------------- F1 - ” Number"of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material---- _---------_-___.-__-_--- ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. Privy: ,.Distance from nearest well-------------------------------------------------Distance from nearest building___--..------_.________-----.-- ❑ Distance to nearest lot line-------- Remodeling and/or repairing describe ----------------------------------------------------------------------------------------------------•------------------- 11 -------------------•-------------------------------- ----------------------------------------------------------------------- ------------------------------------ ------------------ ---------------------------------------------•---------------------------------• ---------------------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------- --------- I he eby ce l 'that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to ws, and•r les and regulations of the San Joaquin Local Health District. k � � (Si ned g )- ner and Contractor) By:------------------------------- -- - L --------------------------------------------(Title)---- t 1' (Plot plan, showing size of lot, ! cation of system in . ation to wells, buildings, etc., can be placed on reverse side). , ° FOR EPARTMENT USE ONLY f APPLICATION ACCEPTED BY__ . - -,.L. ---------------------- ------------------------- ------------- DATE------�-- ��`f 1 REVIEWED BY-------------------------------- --- ---------- ---------------------------------- ---------------------------------------- DATE_-_ BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations:------- -- ---------- ----:--------------------------------------------------------------•------------------------ i -------------------------------------- -------------------- ---------------------------------------------------------------------------------------------------------------------------------------- ---------- -------------------------------------------------------------------------------------------------------------------------------------------------t f. ------------- ' --------------------------------------- ---- ---- ------------------- FINAL INSPECTION BY:- I `= Date �----- -- -- �/ --- ------------------------ 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.Co.