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• ti ��--�=.�---` APPLICATION FOR SANITATION PERMIT Permit No. ._- {Complete in Duplicate} l�/pal(, Date issued ---__-••-------l--- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh 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 OCAT N -----1.-7 - -- -- Owner's Name ------------- ----------- Phon ----- ------ Address-- ----------------- --- - ------------------- ------------ -------------- .d ----- ------------------------ Phone f�� Contractor's Name-------------- -- ----•-• �--- Installation will serve: Residence 'apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/-- Number of bedrooms _c2— Number of-baths --cP Lot size .... f ----,------------------- Water Supply: Public system [ICommunity system ElPrivate DRioepth to Water Table Rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe Hardpan El Application Made: Yes El No �ew Construction: Yes-❑ No FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e tI a6Distance from nearest well-________________Distance from foundation__-______________-_Material-------!---------------------------------------- No. of compartments--------------------------Size---- --------------------•Liquid dept---------- ----------- I-- Capacity --------------------- 'f ' ��__�._Distance #rom foundation__-_ r Distance to nearest lot line___-3.v__. , Distance from nearest well____--____-- �7/9{a Number of lines--------- -------- - ----- Length of,each line-_—Airc------�------.Width of trench-----v �J.------------------- Type of filter material__-5-�.._ Depth of filter material--.. _e ____-____..Total length_________________r�?L7___-----•-- „ Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------__.Distanc<1,.to nearest lot line_________- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-------- Depth ------ 6 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)-------------------- ---•-••----------------•-f-- -------------------------------- 4 Y -----------------------________________________________________________ ____________________________________________________________________________________________________________•_____----______.._.__-.______•_________---__________________----------------------------------------------- '1 ________ _ _________________________________________________ ______________________________________________________________________________________________________________________________________________ I hereby tify tha+ I have pre red this application and that the work will be done in accordance with San Joaquin County ordinances, Sat ws, nd rules d eguiations of the San Jo in Local Health District. R -_/_________________ O'er and/or Contractor} Sined ----- ` /-- ---------- -- By:-------------------•-----------------------•-- }Title) - (Plot plan, showing size of lot, location of system in relation +o wells, bu' gs, etc., can 6e placed on reverse side}. FOR DEPARTMENT E ONLY I f APPLICATION ACCEPTED BY-----------�i -=---------------------- ------------------------ DATE l f 0J ---------- REVIEWEDBY------------------------------------------------------------ DATE-- -------------------------------------------------------- BUILDING PERMIT ISSUED-------- -------------------- ----------------- DATE---- ------=---------------------------------------------- Alterations and/or recommendations:------------------------- ------------------•---•------------------------------------------------------ ---------- --I-------------------------------- ------ ---- ------------------- -------------------------- -------- ------ •-------- ------- ---------------D------------------------------------- ` G�-------- ----- FINAL INSPI_CTION BY DSAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lode, California Manteca, California Tracy, California ES-9 2M Revised 8.'59 F.P.Co.