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APPLICATION FOR SANITATION PERMIT Permit No. .1........ -------- (Complete in Duplicate) , Date Issued This Permit Expires 1 Year From Date issued Application is hereby made to the San ocal Health District for a permit to construct and install the work herein described. This application is made in compliance it ount Ordinance No.-549. -- JOB ADDRESS AND LOCATION_--_ ---�j ._____r----- ------ -------------- --- --- Owner's Name---------------- ------ -- Phone-----•-----•------------------------ Address-------•-------------------•----••--•- -clo--------• yr------- --- ----------•-----•-- ----- Phone_. .. .` -."ZU � Contractor's Name-----------------------------�---- Installation I will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r� /�� ---��-�-�-------------------- Number of living units: __)----- Number of bedrooms � Number of bath6T-------- Lot size _____ __ __ . - Water Supply: Public sys}error �ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel:❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe rdpan ❑ Previous Application Made: Yes ❑ No New Construction: .Yens❑. No ❑ 4 FHA/VA: Yes ❑ No 3 TYPE OF INSTALLATION AND SPECIFICATIONS- (No(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well_____________ ___Distance from foundation-- Mat rial_�__ ---------------- -----Size 9 P• Liquid de th �� Capacity----p&0 -- Disposal dId: Distance f omrnearest well 2,r--- ___Distance from foundatio '__.-_- �--_-Distance to nearest lot line___��_. Number of lines---------- Length of each line----- Width of trench---- Ff---_------------ (� pp"" ,Type of filter materiaLz2_ltfl Depth of filter material___-. _Total length___.______�'la------------------ Seepage t: Distance to nearest well._.___1` _____Distance fr fou dation___`- ____-_.Distance to nearest lot line----------------- X Number of pits_____.___/--------Lining material__ -Size: Diameter._.JS_---------Depth_--A-4_. 7' -------------- Cesspool: Distance from nearest well__--------------Distance from foundation______I----------- material------------------------------------ ❑ 3 Size: Diameter----------------------------- --------Depth----------------------------------`-�r-----------Liquid Capacity----------------------------gals. arest well___________________ ___---.---____.___------____Distance from nearest buil Privy: Distance from ne ..___-____.___ _ ' ❑ Distance to nearest lot line------------------- --- --------------------------------------- Remodeling and/or repairing (describe}----------------- ------ 2 ----- ---------------------------------------- 1 ------------------------ l ---------------------------------------------------------------------------------------------------------- ------------- - ------------- ----------I------------------------- ----------------•----- I hereby certify that I have prepared this application and that thelwork will be done in accordance with San Joaquin County s ordinances, State laws, and r sand regul tions of the San oaquin Local Health strict. ;t Owner and/or Contractor I (iC.l�G� I / I 5� ned _ - -- -------- ----- -- --- - -------------------- - (Title] = -------- ---- ------- --• -- — ---- ----- , -- 4 -- ------ - -- -- - -- s (Plot plan, showing size of lot, c ion of ys}em in relation to wells, buildings, etc., can be placed on reverse side). �t i OR DEPARTMENT USEFONLY APPLICATION ACCEPTED BY----------- ---- - --------- --- ------------------- DATE �115�1--- r � REVIEWED BY ------ DATE-------------------------------------•---------------------- ----------------------------------- ---------------------------- BUILDINGPERMIT ISSUED-------------- --------------------------------------------------------------------- DATE Alteration and/or recommend-tions-------------------- --- --------------•-------------•--- - ---------------------------------- --------------------------------------- - �. �-- -- nor-_ - ------ 1-17 ---------- ----- - moi ------..._..�1----------- �� `-{== -�---------- *�— ----------------------------------- ------ ------� J ----- i i Date--------------- .� (`�.G FINAL INSPECTION BY:.----------- ----- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT f 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 9-'59 F.P.Co.