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fl I� n 9 ` APPLICATION FOR SANITATION PERMIT Permit No. _. .'�..... ' rug (Complete in Duplicate) 3d G + 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--------------------- ----------------------------6 ---------------•---•- --•-•-------------------------------- =Owner`s Name---------------- --------e_0'-,7,-.,, O----- ----- -------------------- Phone-------- •---- -------•---------- f/ Address---�------- --- gyp ^-�' �' Contractor's_ Name l—, �•-•---------------- - Phone.. Installation will serve: Residence Apartment House E] Co ercial ❑ ailer Cour} E] Motel ❑ Other El Number of living units: -,-o'- Number of bedrooms _ Number of bath,l Lot size ----j '_"._.. ____�__% -�_____________ Water Supply: Public s `stem Community system Private e th to ater Table _____!_ ft. pPY' Y Y Y ❑ r❑ P Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ] Hardpan ❑ Previous Application Made: Yes ❑ Nox New Construction: Yesx No ❑ FHA/VA: Yes ❑ N( o j� ? 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------ __e-----Material--------ectc��___ �+ No. of compartments---------�.----------Size_ _Q'__,�`" !._��Liquid depth-------.�______________Capacity ¢dP Disposal Field: Distance from nearest well_-__ _=. ___Distance from foundation____1__4>--------Distance to nearest lot lina__�_ ~r__ Number of lines______________ _ ______ ___ Length of each line___--_ '�SdV�idth of trench________ 3�_________ _____ Type of filter material"___.aoii _ --___Depth of filter material-------- ----.-Total length-------- -___ See age Pit: Distance to nearest well___l_ _`_'_Distance fro fo ndation___._l a..._.Distance to nearest lot line----- Number of pits------------ material----" - _..Size: Diameter_'ZS� _T" __Dept h__.___ _________________ �v Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material_____.._-____-_____________________ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity ----gals. (� Privy: Distance from nearest well----------------------------------------------- from nearest building__________.__.__--------.-.----.-.-_.____. ❑ Distance to nearest lot line--------- --------------------------------------------------------------------------------------------------------------------------"-.------- Remodeling and/or repairing (describe}:------------------------------------------------ -1 ----------------------------------------------------------------------------------------------------------•-•---------------------------------------------------------------------------•----------------------------- x 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=------------------------------------------------------------------------------------------- --------------------------------------(Title)------------------------------------------- - --L. (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------- 0 ---------------------------- ------------------------------------ DATE--------- 9-- REVIEWEDBY------------------------- ------_---------------- ----------------------------------------"--------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------- -• DATE.-------------------------------- --------------------------- Alterationsand/or recommendations:---------------------------------------------- --------------------•----------------------------•------------------------------------------------------------- -------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----•----- - r ------ --------------------- --------- - -- FINAL INSPECTION BY: r ------------- ---------------------------- Date 3 - ( ~--------------- ------------------------------------ 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 F.P.Co. .!{''"`.G A � '. 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