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APPLICATION FOR SANITATION PERMIT Permit No. _/../-�............. (Complete in Duplicate) Date Issued This Permit Ex ires 1 Year From 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 �with County Ordinance No. 549./,� JOB ADDRESS AND LOCATION- _ - ��- 1�.------� -J.. `�}.__�.� U~``J--------------------------------------------------------------•-------- Owner s Name-------------------•------- ''! �'"` - Phone ------- i�47 Address-------------------•---•--------- -----•-- e Z77___� S;WContractor's Name___________ __ �-'�_---r_ C.__-.-___.-"'�� t Phone �" Installation will serve: Residence EiU_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1_._ Numbee of bedrooms _ '__ Number of baths _f---_ Lot size Q-- d______________________________ Water Supply: Public system ❑ Community systems - Frivate ❑ Depth to Water Teble* `'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑w Sandy Loam Clay Loam b Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No FHA/VA: Yes.❑ No ❑ A R TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within'200 feet.) SepticTa� Distance from nearest well-----------------Distance from foundation_________________ Material___..____-..___.-_.._____.________.__...________- ' No. of compartments--------------------------Size--------------------------------Liquid depth-k---------------------.-Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation------------------'Distance to nearest lot line_._________-_____ ❑ Number of lines-----------------------------------Length of,each line----------------------------!Width of french------------------------------------ Type of filter material-------------------------Depth of filter material_____.`-------------Total length----_------_----_________-__-------__-_. Seepage Pit: Distance to nearest well__yf ____Distance from6f�oun ation_1__6________---JD}'s•ta Fe t earest lot line_.-- ' '-+t- 14 Number of pits------2-___._______Lining material___�J_t_ ` ize: Diameter__��c_ X--Depth.--- ---______________________ Cesspool: Distance from nearest w911_________________Distance from foundation-----.------------- Lining material------------------ p Size: Diameter-------------------------------------.Depth--------------------- ------Liquid Capacity---------------------------- gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----__-__.___-__----_____-_--__-__---_. ❑ Distance to nearest lot line------------------------------------------------•------------ - -------------------------------------------------------------- Remodelin and/or repairing (describe:__ ._-� �1r ` ' F � ' ----- ---- - -------•-------' r' 1 ------------ c .. . -----------------•.----- '- , -------------------- --------------•--------------------------------------------------------------.----------------------------------------------------------------•-----•------------------- --------------------------------------------- ------------------------------------ --- ------ I hereby ce tify thaavet-I hprepared this application and that the work will be done in accordance with San Joaquin County ordinances, S �t I "ws, and rules and regulation's of the San Joaquin Local Health District, (Signed) ---------------------------------------------- ------------------------------------------------- (Owner and/or Contractor) BY:----------------------------------------- -------------I--------------------------- -----------------------------------------(Title)------------------------------------------- -------------------- (Plot - -- -------------- (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r OR.. PARTMENT USE ONLY APPLICATION ACCEPTED BY---------- --- ------ ---- --------------------------------------- DATE--- �� ' --------------------- �/Q REViEWED BY --------- ------------ ---------------------------------------------- DATE------------------------------------------------------------ REVIEWED PERMITISSUED---------------- -------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-----------------------------------------------------....-----------------------------------------------------------------------------------------...-...------ --------------------------------------------------------------------------------------=----------------------------------------------------------------------------------•------ •------------------------------------------ I -----•--------------------------------------------------- ------------------------------------------------------------------------- ----------------------------------------------•------------------------------------------ FINAL INSPECTION BY:.......w.. ------------------- Date • X1 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 Rcvised 8-'59 F.P.Cu.