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APPLICATION FOR SANITATION PERMIT Permit No. ...�_ .91.. (Complete in Duplicate) tj L / This Permit Expires 1 Year From Date Issued 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 LOCATION- -- - --------- 2,h • "'-` Owner's Name_____ r -------------------- Phone Address-------------------------------------------•------------------- _ Contractor's Name_. :_ s' �+ .. ` ---------i -------------------------- Phone----------------------------------- JOP Installation will serve: Residen e f❑ Apartment House E] Commercial ] Trailer Court El Motel E] Other ❑ Number of living units 1"-a<,A-bgs�oms -------- Number of baths ----- -- Lot size --——A!t______________________________-_ Water Supply: Public system E] Community system E] Private Z Depth to Water Table _70_ ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 0 New Construction: YesA No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 0%, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_.�-4�P----Distance fpm foundation__r(,2------------Material- ------ No. of corn partments__�---------------------Size,� ---- __----------Liquid depth....V-._.__---- Capacity_ 1l1_�____ Disposal Field: Distance from nearest well _,-1."___Distance from foundation_A&!A-------Distance to nearest lot line__ ---------- Number __---_- Number of lines___________ __________ Length of each line-Q _ ......?PvVidth of trench_.ZY-----------------.___..__ Type of filter materia , _Depth of filter material_A-f-_------------Total length__. 670____________________________ Seepage Pit: Distance to nearest welL�2rro---------Distance rom foundation__-bG'.__.___Distance to nearest lot line_ -------- Number of pits----�--------------Lining material/ ___--...Size: Diameter---- --------- ------------------- Cesspool: D+stance 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 ---------------------------------------------------------------------------------------------------------------------------------- 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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------------- ---- -- -- -- ------------------------------------------------------------------------------------------------- -----------(Owner and/or Contractor) By-7c - ---------------------- —'------------------------ ----------------------------(Title)---641- x- 7- "9-4---------- --- ---- ----------- (Plot - - ---- (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 APPLICATION ACCEPTED BY_ _______________________ DATE__ w ---------------------------------- REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------ DATE----------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:--------------------------------------------------- -----------------------------------------------.. ------------------------------------•-------------- -----------------------------------------------•------------------ ---------- ---------------------------------------------------------------•--------------------------------------------------------------------- -----•----•--------•-----------------------------------•------------•-------------------------------------------------------------------------------------- --------------------------------------------------- ------------- FINAL INSPECTION BY; r `_ ' '' Date L. -- ---- ---- -- 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.