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APPLICATION FOR SANITATION PERMIT Permit No. ... .30.l... (Complete in Duplicate) This Permit Expires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal thp work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI N_-- ------- -/k. ----------- - --- hv-n -----W Owner's Name- .'!i`--------------------- --- - ------------------- Phone------------------------------------ Address------------ ------------------------ ._,.._Address------------Ao.: ,, �* Contractor's Name-,tv ,tt -L.-- -----. Phone-------------------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ Number of living units: ___l.___ Number of bedrooms ___ Number of baths _2r___ Lot size Water Supply: Public system ❑ Community system ❑ Private Ej Depth to Water Table _Q_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Z Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No'❑i New Construction: Yes X No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---rd!_____Distance from foundation--- ------------Material_-_�v►grt/�---------_---------_ ® No. of compartments__.__± ------------------Size3-".._pkl_x_!�-------Liquid depth-------- ---------------_Ca acit z�7W Disposal Field: Distance from nearest well-_6�'____.._Dista_nc from foundation-'F-0'______.__.Distance to nearest lot line5,0,.________ ® Number of lines---- " _.f`. _ - . ---Lfe' of each line------1_97-A----------------Width of trench---- -.`�-"--_----_-_-_- Type of filter materia "_fVtK__.___Depth of filter material-__ -V"--------------Total length____ Q_:____ Seepage Pit; Distance to nearest well---------------------- from foundation------------------- to nearest lot line_.__.___-_.__ Number of pits----------------------Lining material----------._._.-------Size: Diameter-----------------------Dept h---_--------------------------_- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-________________________ ❑ Size: Diameter-------------------------- -----------De th--------------------- -•----------------------------Liquid Capacity-------------------- -------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line------------------ Remodeling --------------- emo a ing and/or repairing (describe):----------------------------------------------- ----- ------------------------------------ --------------------------------------------------------•---------------------------- - ------------------------------------------------------------•------------ ---------------------- I hereby certify that I have prepared this application and +hat the wo.k will be done in accordance with San Joaquin County ordinances, aws, and rules and regulations�thean Joaquin Lo Health District. (Signed --'---------- -- -- -------- ----------------------------------- -------------------------------------(Owner and/or Contractor) By:- --------------------------------------------------------------------------- ---------------------------------------------------(Title)------------------ ----------------------- - ---- ------ - t (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..... �rDATE 'Y/'(/ --------- REVIEWED BY ------------- -- •--- ------------------------------------------------------------------------- DATE------------------ BUILDINGPERMIT ISSUED-------------=------------------------------------------ --------------------------------------------- DATE----- -------------------------------------------- Alterations and/or recommendations------------------------------------------------------------------------------------------------------- --- ------------------------------- •-------•--------------------------------------------------------------------------•--------------------------- --- ------.------------- ------------------------------------------------------------------------------------------------------------------•-----------•----------------•--------- ------------------------------------ ---------------------•---------------------------------------------------------------•--------•-----------------• --•--•------------------------•-------- - ---------- ------- ------------- l FINAL INSPECTION BY• - ----------- 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 FS_9-2M Revised 8-'59 F.P.Co.