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APPLICATION FOR SANITATION PERMIT Permit No. .-Pm - I •. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .._1�-D Application is hereby made to the San Joaquin Local Health District for a permit to construct �� all the work herein described. This application is made in compliance with County Ordinance No. 549. /----oe.✓e--��1Y__►h---1-t.4J�lr>----------------------- ----------- JOB ADDRESS AND LOCATION ------- Owner's Name ------------------- A -A --pr------ __ - ----------------------------------- L Phone~ ------------------------------------ Address ��°-----`-S��s----- ��% ICI7 ------------------------------------------ ---------------------- Contractor's Name___________________tz� a -,rte- `� '��-- -- - Phone_ --------------------------------------------- -- ---- Installation will serve: Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/--- Number of bedrooms ._y-- Number of baths -------- Lot size Water Supply: Public system ❑ Community system ❑ Private 2 Depth to Water Table ___Y,rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan ❑ Previous Application Made: Yes ❑ No `4 New Construction : Yes V No ❑ FHA/VA: Yes ❑ No CK TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public. -§ewer is available within 200 feet.) Septic Tank: Distance from nearest well --- 7j_'___Distance from foundation_/D ---,Material f__ -_------------------------------------- No. of compartments...__ .__ Q-��-- ----Size--------;-------------- -----Liquid depth------- ,�--------Capacity76�1�� Disposal Field: Distance from nearest e`?_ Distance from foundation-----9104-Distance to nearest lot line fL Number of lines___________ .___- Length of each line_ ------ ��---.Width of trench --- -------- a---_ �+ Type of filter material-__-1____44—k-_-Depth of filter materi ! '_ ------- -- - --------Total length-- ----------�is�-0---------- --- Seepage Pit: Distance to nearest well_._ -_-_______..___-__Distance from foundati __ _ _ ____________.Distance to nearest lot line Number � v ❑ Number of pits Lining material- Size: Diameter Depth --- Cesspool: Distance from nearest well ________________Distance from foundation_ .......__ __.....Lining material ------------------------------------- El Size: Diameter ------------------------------- ------ Depth ---------------------------------- ------Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well________________ Distance m nearest building ---- ------------------------ Distance to nearest lot line____________________ l loof r U C z� f- zi7c+u8 Remodeling and/or repairing (describe): -------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- --------------- 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) ---- = - (Owner and/or Contractor) By. ---------------------------------(Title) - 1 i iFr-.4. t �+1 [Piot plan, sho g size of Io}, loc ion of system in relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- - DATE------_-'-----�1.-_--6__ - --------------------------------------------------- REVIEWED BY.--- ----- ------------- DATE -------------------------------------------- - BUILDING PERMIT ISSUED ------------------------------------------------------------- ----------------------- DATE Alterations arid/or recomdai -- ---------------------- - - ---- -m -n`- --- . )---------------------•----------------------------------------------------------- ---- --------------------------- FINAL INSPECTION 8Y:Y�-( .,----------- 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 ES -9-2M Revised 6-'59 F,P_co, l\� f'