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APPLICATION FOR SANITATION PERMIT Permit No. _.1..1 .- (Complete in Duplicate) � This Permit Ex ires 1 Year From Date Issued Date Issued3"� 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__. I -`------'-E JYI1_.tl1rA'' Owner's Name--- d. • -------------------------------------------------------------------- Phone_j! 6...;?.-Z/0j__ Address------. ;t_. --._" 3o-?S_ s.4_h_A�' Cs ll_c -----•--------------------- ------------•-------•------------------------- Contractor's Name-------- f?'-------X -..7 ---------------- ------------- Phone---------------------------• - Installation will serve: Residence g] �Apartment House ❑ Commercial ❑ Trailer 'Court ❑ Motel El Other El Number of living units: ----!-- Number of bedrooms __3._ Number of baths __ ---__ Lot size .-�V___cDC1"e--------------------------------- Water _____----___________ ____Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table Yi_✓ft. Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam [] Clay ❑ Adobe K] Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or,cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wellZ---------------Distance from foundation___________________Materiaf_._-_____._.___-____._..____________.__.________. j§<1311h j No, of compartments---------------- `--" Size------•----------- -------------Liquid depth---------------- ---------Capacity--•----------------- Disposal Field: Distance from nearest wefl_._*rr_7v-----"Distance from foundation____ -----------Distance to nearest lot line_--------___-_--- [� Number of lines---------------I---__------------Length of each line---------- b-----------_1p/idth of french......'.2-9 p__ Type of filter material--_?v-4-4 p -------Depth of filter material___.ZJ-_.*4--------Total length---------- --- _ d_.-�____________________--- Seepage Pit: Distance to nearest well__--------------------Distance from foundation-----------....._..Distance to nearest lot line______-______.__ L� ❑ Number of pits-----=----------------Lining material-----------------------Size: Diameter----------------------Depth-_------------------------------. Cesspool: Distance from nearest well------------------Distance from foundation---._..-_-_--____-..Lining material-----__--___-_--_._.___--.___--_-._-_. ❑ Size: Diameter----- I------------------------------Depth--------------------------------------------__......Liquid Capacity--- ---------------- --gals. L Privy: 1, Distance from nearest well------------___----------------------------------Distance from nearest building__=_.----------------------------- ❑ Distance to nearest lot line----------------------------------- '' --- - Remodeiing and/or repairing (describe)-------------------------------------------------------------- I: ----------------------------------------------------------------------- - -------------------------------------------- ----------------------------------------------------------------------------------------- -------------------------------------- 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, d rules and `regulations of the San Joaquin Local Health District. {$i ned g )------------ - - - ----�- -------------------------------- --------------- ------------------------------------------------(Owner and/or Contractor) By:-----'=----------------------------------------, ---------------------------------------------------------------------------------{Title)- ------------------- ----- - ------------- - .............. (Plot plan, showing size of lot, locationof system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -------- --------------------------------------------- ----------------- DATE-- r REVIEWED BY i DATE ----------------------------- ------------------------------ BUILDING PERMIT ISSUED---�---------------�----------- ----------------------------------------------------------------- DATE----------------------------------- -------------------------- Alterations and/or recommendations-- - --------------------------------------------------------------------------•------------------- -------------------------------- ------------------------- ---------------------------- ------------------------ -------•---------•------ ------------------- ---- x `` -- i = -------------------- - :I. - - -------------------------------------- --------------------- -- -------------------------------- ------------------------------------------------------------------------------------------------•-------------- -------------------------------------------------------------- FINAL INSPECTION BY- ----------- - -- ---------------------------------------- Date_ '`.2 { SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street X300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F,P,Co.