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APPLICATION FOR SANITATION PERMIT Permit No. -----/._,;z.,/S/ (Complete in Duplicate) Date Issued .-"_-��6444 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 herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC TION + i +CtA ° '"==" i------ Owner's Name---- -�-- �-.-- ------ ----------------------------------- ---------------- - - ----------------- --- Phone ... Address--------_1 A8� ...ly1-r-------------- u ----------- --------------------------------------------------------------- Contractor's Name- ---•------------------ •---•- ------------------------------------------------------------------------------------------ Phone------------------------_-------- Installation will serve: Residence #] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1------ Number of bedrooms __ ___ Number of baths __t____ Lot size _ y __ --•---------------__________-_____.__ Water Supply: Public system ❑ Community system ❑ Private [4 Depth to Water Table,5-.Q__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No % New Construction: Yes ❑ No IX FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi _Tank: Distance from nearest well-_______________Distance from foundation--------------------Material_____________________._.__________._.__.-___-. No. of compartments------- ------------- ----Size--------------------------------Liquid depth---------------- ---------Capacity-••-------------------- kil sposal iel Distance from nearest w,ell---YA-__.._Distance from found _—ation_ 0�---_____.Distance to nearest lot line.__s-------- Number of lines-----1 Lengtk of each line-------,7 ---------Width of trench-- Type of filter material- Depth of filter material---A�*------------Total length__._ ___�� Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__.____._________ ❑ Number of pits----------------------Lining material-----------------.----.Size: Diameter------------------..---Depth-----------------------------.--- 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 nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe) --------------------------- ---------------------------------------------------••--------------------------------•------------•-_-------------- --------- •-------• -- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- -------------------------------- -------------------------------------------------------------•-------:-------------------------------------------------------------------------- ------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e la nd rules and regulations of the San Joaquin Local Health District. {Signed)-_ ___- __ __ _ _ _._ Owner and/or Contractor By:--------------------------- --- ----------------------------------------------------------------------------------------------------(Title)--------------- --------- - ---------- ----- -- ---- (Plot plan, showing size oWt, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_411-1-1 -------------------------------------------- DATE----?--is-Go.----- REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE------------------------------- - BUILDING PERMIT ISSUED---------------------- ------- -------------------------------------------- DAT --- Alterations and/or recommendations:___ _ -----'Vale--___,! ____ __ _- _ __ -_ ________________________ --- ----- ---- - ---- -- ---- ----------- --------------------------------------•--- FINAL INSPECTION BY:.- Date--- ---- ------ y 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.