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0 APPLICATION FOR SANITATION PERMIT Permit No. .3.. - (Complete in Duplicate) This Permit Exvires. 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and instal! the work herein described. This application is made in compliance with County Ordinance No 549. JOB ADDRESS ANDL A Owner's Name------- Address..----- ---------- '.- -------------------------------- -------- �- ---------------------------------------- Phone----------------- - Contractor's Name •------------------------------•--------------------------------- ---------------------••----------------------- Phone.------ --- Installation will serve: Residence ❑ Apartment House E] Commercial El Trailer Court E] M_ otel Other ❑ Number of living units: _-f. Number of bedrooms --CJ--. Number of baths -- ---- Lot size --- Water Supply: Public system ❑ Community system ❑ Private Depth to Water TableXL,�Ift. Character of soil to a depth of 3 feet: Sand (] Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No R" New Construction: Yes ❑ No FHA/VA: Yes ❑ No Jt_ 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__.Z_QV_�Distance,from foundation__//e_----- -. i s r� Material---_ ---___..� ll� No. of compartments----- --------------��_-Sizes k"__ 0XA:Z iquid depth----�.�----- Capacity y�+��--.--- Disposal Field: Distance from nearest ell.,/q Distance from foundation.__ - - Distance to nearest lot line fie-._--- , ---------• �- Number of lines------ -------- -Length Length of each line_f�'---------------_-Width of trench._9 :�� Type of filter material -- / `-Depth of filter material -------Total length----Sfp...............---------_ Seepage Pit: Distance to nearest well_/069-- -,Distance m fo ndation_-48----------Distance to nearest lot line___--- Number of pits--, -------------Lining material_ �_____ ..Size: Diameter-_ __�.--.___.Depth-- � -------------------------- 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 El Distance to nearest lot line__________________ Remodeling and/or repairing (describe):--------t .,4�'_ ....... --------------------------------------------------------------------------------------- \ -------------- ------------------------------------•---------------•--------------------------------------------------------------------------------------------------------------------------------------- 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)_ — -- By------------------------------------------------------ - --- ------ - --------------------------------------------(Title)---- . (Pot plan, showing size of lot, location stem in relation to wells, buildings, etc., can be placed on reverse side). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- � e&-------------------------------------------------------------------------------- -- DATE-.--'9_'-�--.6-0--- ------------ ------------- - REVIEWEDBY------------------------------------------- - ------------------------------------- DATE BUILDINGPERMIT ISSUED------------------------------------------ --------------------------------------- ---------------- DATE----- Alt ----------------------------------------------------- ------------------------------------------ ion ats and/or recommendations: ----------- --------------------------------- ---------•-------•----•------•------------------- �'----1 -6-o-------------;------ 3 --------------------- Z ------------------------------------------------------------------------------ --- ------ -- FINAL INSPECTION BY------------- ---- ---------- Date------------ _ - 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 E5-92M Revised 8-'59 F.P.Co. +