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z''? Permit No. APPLICATION FOR SANITATION PERMIT i (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued 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. 54 . k JOB ADDRESS AND LOCATION_ _:I _.... r--------� - 41V s Name__ Phone-------------------••----------• -- Address-----...�------------ ------ : ---------•---------------------•-----------------------•----------------------------------------.------_------- --- ------ �J 4 Contractor's Name-------A- �-.."--- 1 `u'� -------------•-------------------------------------------------------------------------- Phon"s40_.:-- Installation will serve: Residence P1 r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other F1Number of living units: J.--- Number of bedrooms Number of baths Lot size <_IM___------------_----------------- Water Supply: Public system p Community_ system 6 Private ❑_ -Depth to-Water Table Jl� ft. i Character of soil to a depth of 3 feet: Sand ti Gravelf[] Sandy Loam❑ Clay Loam [I ❑Clay Adobe� '- rdpan ❑ Previous Application Made: Yes ❑ iNo� New Cornitruction: Yes ❑ No [R FHA/VA: Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , No septic tank or cesspool permitted if public seer is available within 200'feet.) S tic Tank: ' Distance from neares....................... well_________________ istance from foundation-`----_----.-----.Material_-__-.._-____--- .--__---._-_-_.-------_.-__. P P ' .--:Size---------------- ------ --Liquid de th----------------------- Capacity �� No. of compartments--- ----- --•-•-• ---- q p ----- --------------- Disposal ----------;--- Disp,�osal/rField: Distance from nearest well___._:l-----Distance from foundation___ ------Distance to nearest lot In�e_s�.__.__. � lJd' Number of Length of each line------�_R-- f--------.Width of #ranch... ------------------------ Type-of ----------Type`of filter material/ Depth of filter material__',–XP,-------Total length--_.--rX_G___r_____________________ ' Seepage Pit: Distance�to-nearest well____________________Distance fr m foundation___ /-.-____.Distance to nearest lot line___.___.__.__ !n ' [� Number of p`ts____�---------------Lining material x-r-��_-Size:;.Diameterx- f�------.Depth...__ . - V -------------- Cesspool: Distance from`'nea st well-----------------Distance from foundation- �_--_1:__.___Lining material-------------------.-----------------. i ❑ Depth------------------------- -- - ---Liquid Capacity------ " gals. Size: Diameter -----------------Distance from nearest bu;lding-------------------------------------- -- Privy: Distance from nearest well-------------------------------- ❑ Distance to nearest lot line------------------------------ ---------------------------------------------------------------•--------------------- ; ---------------- - - -- -- --- -- - 00 Remodeling and/or repairing (describe) � � f _ _______________________________________________________________ ______________ I --------------------------------------------I------------------------------- ----------- _________________________ __---------_------------------------- hereby certify that i have prepared this application and inaccordance- -- - ---- -. ui -- ' hat the work will be done in with San Joaquin County f ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed) ----- -- ---- --------------- ------------------- { Contracts` G � ' -.-�-----------------------[Title} ---- ' w buildings, etc. can be laced on neve e). -------------------- By:--------------------------------- ----- ---- (Plot plan, showing size of lot, location of syste i relation to w ells, P FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ----- ------------------------- DATE---- s -------------- REVIEWEDBY------------------------------------------ ----- QATE.- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------- ---- DATE------------------------------------------------- ------ Alterations and/or recommendations---------------- -------- • ---------•--------------------•----•----------•---••--•------------------------ •-------- ---------------------------------------------- -------------------------- - --------------------------------------------------------------- . ----------------------------------------------------------------------------------------------------- k - -------------------------- -- ------ ----- - - - - FINAL INSPECTION - Qate f1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak-street a �� •132 Sycamare.Sfreet4 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5.9-2M Revised 8.'59 F.P.Co.