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APPLICATION FOR SANITATION PERMIT Permit No. ..r..'............... (Complete (Complete in Duplicate) �� 0 _ _From Date Issued Date Issued°______ _________ ______ This Permit Expires 1 Year •,_ Application is hereby made to the San Joaquip Local Health District for a permit to construct and install the work herein described. This application is made in compliance with 660y. Ordinance No, 549. JOB ADDRESS AND LOCATION. �.tr ``"= •-- -- -----------��------ ` � ' i _.---... Phone- Address......... O_- Owner's Name---------------- ----- ----- - -- - -- --- ---- - - - -------------------- ••--------------------------- f ......... •- ----------------------------------------------- ---.._..-----...-------------------------------------------------------------------•--- Contractor's Name--------------------- <' Phone r v •---------------- ----------------------------- -------------------------- ----------------- Installation will serve: Residence [Z4 Apartment House ❑ Commercial I9 Trailer Court ❑ Motel ❑ Other ❑ g - „� t i ` ---/ Number of baths _� Lot size ___,� Number of livor units: _ ._._ Nurriber'tof bedrooms ._ ___ ._._!��/'�_._Z-.�_._Cr__s_._.._____.__.___ r !s Water Supply: Public system �, Community system 0 Private F1 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [3 °Gravel°,❑ Sandy Loam ❑ Clay Loam [W Clay E] Adobe E] Hardpan F]Previous Application Made: Yes El No J4 New Construction: Yes ❑ No S FHA/VA: Yes ❑ No [W 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_-_-__ -..Distance from foundation____----_'Jvv_.Materia4..... 94 No. of compartments------'-J - -_-Size------ -A..J"'Ziquicldepth--------�------------Capacity---- sqs_°/ Disposal Field: Distance from nearest well.._.--__-`___.Di tante from foundation__.-l^'-------Distance to nearest lot Number of lines_____-__...__-t-- _-. ---- Len Th of each line------------------ Width of trench.__.____._z------.----_-__.-_ 9Q �� 0 Q Type of filter material___ "c.. _Depfh of filter material----_-__,/__,•--_-___Total length__-_._--.--17„t------------------------ Seepage -----------------____. P g Number of pits �_.______ Linin mate ante from foundation--- _x._47___ Distance to nearest lot line_._.�_d._._ See a e Pit: Distance f nearest well --____g____Di dial___ �'----Size: Diameter----°3_�.............Depth------'Z_,t_":'___--___.._--- ` 1% Cesspool: Distance from nearest well-----------------Disk'ance from foundation-_-._--------------Lining material-------------------------..___-__-___. ❑ Size: Diameter------------------'--- .--------------.Defth---=-------I "t--------- '- --------------Liquid Capacity----------------------------gals. . Privy: Distance from nearest well---_:.!._-,+__r�___�_-- ------------Di'f,,ncejf.om nearest building------------------------------------------ F1 Distance to nearest lot,,line-..--_-_---_ - i Remodeling and49r repairing (describe)--- = ' " -- --------------- f ------- ,., . ------------ ------------------------------------------------------------------------------------------------ -----••-- -------------------------------------------------------------� ----------------------------------------------------------------------------------- -------------------------------- I hereby tify that I have prepared this application and that fke work will be done in accordance with San Joaquin County ordinance ate I and rules and regulations o San Joaquin Local Health District. r (Signed)-- -----'-f es -4------ ------ ----------------------------------------------(Owner and/or Contractor) By:---'------------------------ --------- I------------------=------------------------------------------------- ---------(Ti+le)-------=------ ------------------------------ ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, e* c` c-en bezplaced on reverse side). FO DEPARTMENT USE ONLY '0 f APPLICATION ACCEPTED BY-------- _ - -- ---------------------------=------------ DATE--------5'r L REVIEWED BY-------------------------------------------- ------------------------------------------------------------------------------- DATE-------- BUILDING PERMIT'ISSUED--------------- i-------- --------------)------------------------------------------ Alterations and/or recommendations--I---- -- -------------------------------------------------------------------------------------•-•-----••------- ---------•-•---------------------------- ' 1 I ------------------------------------------------------------------------------- - FINAL INSPECTION BY(---,/--------- -------------- --------- ---- - - --- bate--------------- - ------------ SAN JOA UI LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" reef Stockton, California Lodi, California Manteca, California Tracy, California H-9-2M Revised 8-'59 F.P.Co.