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APPLICATION FOR SANITATION PERMIT Permit No. ...U.2_�_I.-�____ (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued _ _` mApplication 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. I JOB ADDRESS AND LOCATION --- k r c -------moi : -- x ' _ . _ ' / 1 Owners Name--------------------- r_._./ <a .. r---------------------------------- --------`=------------R. Phone--/ 1 Address--------------------------------5r .��-------Ad, ----- ------------=•-----------------•---------------------------------------------------------------------------------- R Contractor's Name------ '------------------ ----------- Phone Installation will serve: Residence EVApartmenf House ❑ Commercial ❑ Trailer Court 0, Motel ❑ Other Number of living units: Number of bedrooms ___-r-__ Number of baths Lot,size _ t `"4 -._ .c ____`l--------- - Water Supply: Public system ?9. Community system ❑ Private .[g Depth'to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam El Clay Loam ❑ . Clay ❑ Adobe4R Hardpan 0,--- Previous ---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.) 40, " / -Se tic Tank: rest well__ _____Distance — -� -- -- 5ize__ __ ,Liquid depth---_ __.__. _ ._CapacityNo. of compartments_______. jMaterial _t ® Disposal Field: Number ofol lines--! welL��6_�__Distance 'from foundation_.._��________:Distance to nearest lot p I - _ _ -- Length of each line________. �.___ ' Width.of trench.____„2.,i Type of filter material_______��Depth of filter materia _____._____ _ ..Total length----------- _____________________ ❑ Number of its----------------------Linin material---------,------ --_'_.Size: Diameter--------------.-_- ___De th--------------------_---_--.-- p g Pit: Distance to nearest well___________________ p See a e p - g _Distance from'foundation_________________ __Distance to nearest of ine._____.______ Cesspool: Distance from nearest well-________________Distance from foundation---------------------,Lining material---------..___.._____.__--_-.______ �`V? ❑ Size: Diameter-------- -----------------------------Depth------------- ------------------------------------- 'Liquid Capacity----------------------------gals. Privy: Distance from nearest well _._.7________________----------------Distance from nearest building------------------------------ __.____. ❑ Distance to nearest lot line----------------------------------------------------------------------- --------------------------------------------------------------------- \! Remodeling and/or repairing (describe) `------------------------------------------------•-------------------- ----------------•--------------------------------------------------- ------------------------•-------------------------------------•--------------------------=---- ---------- ----------------------------------------------------------------------------------------------------------------- ------------- ---------------=-------------------=---------- --------------------------------------------------------------------------------- -- , &-.0. *. --- --------------------------------- ----------------•-=---------------------- ------------------------------------------------------------------------------ ------- ------ ------- I hereby certify that I have prepared this application arid-fh t t'he work will"be done 1n accordance with San Joaquin Count ordinances, St aws, and rules and regulations of the San Joaquin Local Health District. a , (Signed) --= --- `'�� -------- ------------------ ----------------------------------------------(Owner and/or Contractor) B -----------------------------------------------------------------------------------(Title)------------------ - --,------ -------------- (Plot -----:---' ( plan, g y dings, etc., can be placed on reverse side). 4 Plo# Ian, showing size of lot, location of system in relation to wells, buil FOR DE ARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------------------------------------------------------- DATE----------!y- '. f°' ------------------ REVIEWEDBY--------------------------------------------- ------------------- -------------------------------------------------- --•--- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------ -'--------------------------------------•---- _'-�--------------- DATE---------------------------------------------------------- Alterations and/or recommendations:-�-----------`---°---:---- -----------------�---------------------------------------------• •----------_---- ----- .V �•�7•-` _ .�-cam /��fe.�..�s� rs-...� - --- ---------- --------------' FINAL INSPECTION BY:_..__ -------------- Date tam YSAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 8 i4 North "C" Street Stockton, California . Lodi, California Manteca, California Tracy, California -�.�. Es-9-2M Revised 6-'59 F.P.Co.