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APPLICATION FOR SANITATION PERMIT Permit No. ....._ �_. (Complete in Duplicate) j 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 a�� all �rk herein descried. This application is_made incompliance with County Ordinance No. 549. JADDRESS AND LOCATION f/4444 ,,__// Owner's Name v� � !?�- ?'!?------ � ----- Phone ----------------- Address-. -------- f �"?! �' I Phone ----------------------------------- --------------------------------- -- Contractor's Name ..... Q�-r�t_Cs-------------------------------------------------------- ------------ - Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I------ Number of bedrooms 24.__- Number of baths 1_% Lot size ---�-d_A-T___��__�_- --------------------------- Water Supply: Public system 00 Community system ❑ Private ❑ Depth to Water Table __._____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,± Clay Loam p Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ Noa New Construction: Yes_A] 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_/_&%rA__.__ Distanc fra foundation_1C________-Material____ ----_-__-_- -y' No. � of compartments----------------_�_____Li--quid depth---_ '----.---------- Capafuty------- t. Disposal Field: Distance from nearest well_/d.V.----- Distance from foundation _/V ----------- Distance to nearest lot line --- _- ______{ Number of lines_________ Length �] I] ____-__-_ ___---____ of each line ______'_-_4X_._. Width of trench --- ,�_�t"-------------- ______? Type of filter material. -__Depth of filter material__ -?"_____.__._ Total length__/__'�_________________________#, a ^. Seepage Pit: Distance to nearest well__-/ -------- Distance from foundation -------------------- Distance to nearest lot line ______-._--.-.__. �-- -40— 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}:____--__ _ ,�-�?�t.-�_ _ ----------------- -------------•-----=----------------------------•----------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- 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. �Si ned/ g )----------------------------- ---------------- ---------(Owner and/or Contractor) $Y:-----------------------••---------------------•------------------------------------------------------------------------------------(Title)------------------------------------------ ---------------- (Plo+ 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 ---A,- ---------------------------- REVIEWEDBY ------------------------- ------------ ------------------------------------------------------------------------------------- DATE ------------------ BUILDING PERMIT ISSUED ------- -__------------------------------------------------ ------------------------------------------ DATE Alterations and/or recommendations:------- -- --------------------------------------------------------------------------------------------------------------------------------- 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 ES -9-2M Revised 6-'59 FP.Co.