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APPLICATION FOR SANITATION PERMIT Permit No. ..!-!-• � (Complete in Duplicate) pate Issued :=�!_/..�' -- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh 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------ r �------ �l -r `'`- -- - ------------------------------ - ---- Phone------------------------------------ Owner's Name---------Address-.----_------ ------------------------------------ ---------- Contractor's Name----- `••-- �-��--�--I-_S-�-�----- -—Y----..------- -.0------------ Phone...--- A-4-0-7 Installation will serve: Residence TK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ---- __ Number of baths ---I--- Lot size - 7.�_7 ---------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table v ft. Character of soil to a depth of 3 feet: Sand F-1Gravel F1 Sandy Loam [I Clay Loam ElClay ❑ Adobe Hardpan ❑ Previous Application Made: Yes F1iNo& New Construction: Yes El No Z FHA/VA: Yes No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic a Distance from nearest 1 well_________________Distance from foundation__._.-____.._____._.Materia-_____._______-.____-_-_ ________-_....____ _.. No. of compartments--------------------------Size----------------------------=---Liquid depth--------------------------Capacity----------------------- I ' r Dispos Distance from nearest well_-A/k_vJS_7 Distance from foundation---/Q----------Distance to nearest lot lines--..-------- ---.___Len_Length of each line---- �f�- ---- Width of trench___._2/�-------- ------- Number of lines-----------1--------- ---- g it l Type of filter material----- -Ce......Depth of filter material------IT--------Total length------t';,?-0---_•_______________ k See pa Distance to nearest well_____1ll�_t±�+ -Distance from foundation____1-Q-- ---Distance to nearest lot line x` ---• ??T . _ Depth-----;�4----- ------ �L Number of pits_.:._I-----_____-_-Lining matenal____�t?[�--.Size: Diameter--------- 0i ____ __ ________ Cesspool: Distance from nearest well----------------- from foundation_-------------------Lining material-------------------------------------- - F1 Size: Diameter-- -------------- ------------------Depth--------------------- •------- ------Liquid Capacity----------------------------gals, Privy: Distance from nearest _____ _________ arest well-_-._.___--------------------------------- Distance from nearest building_______________ _______.. - - . ❑ Distance to nearest lot line-----.--- --- ----------------- -------------------------- J ' '� _% � -- ------- -- 0,1 -. - ! Remodeling and/or repa.ring ....{descrsUe�:_ _._. _ _. P { �' - . I`77! -------- -j -- r ------------------------ - --------- ------- ----'----------- ------- ------------------------------- k ' ----- - - - - ------ I hereby certify that I have prepared this applica ' n and that a work will be done in accordance with San Joaquin County i ordinances;-State laws, ind rules and tions of the San Joaquin Local Health District. . :-- Owner and/or Contractor) {Signed)---------------- _ _ I -------- - {Titl e]_ (Plot plan, showing size of lot, location of syst m m relation fio wells, buildings, , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- - -------------- -------- ----------- -----• DATE---------- ----- ---------- ----------------------------------- DATE------ - ---------------------------------------------- ftEVIEWED BY DATE ----------------------------- BUILDING -----------------BUILDING PERMIT ISSUED-----------1 1--------------------- ------------------------ - ----------------------- Alter tions, nd/or rec mendations:_--__--.-._------------------------------- •----------•---------------------•--------------------------------------------•-----•-----•.--•-- _�vG ---------------------------------------------------------------------------------------------------------- -- 'lr --------- ------------------i�-------- ----- ----------- ------`�' ---------------- - ----- ---- ------------ ----------- ----------------------------------------- - ---------------------- --- � c� �. j e •----• Date---- � -- -- ------�• ------- --- ------ ----------- -------- FINAL INSPECTION BY--------- - ----------------- = SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Strea+ 132 Sycamore Streot 814 NorFh "C' Sfreet 130 Soufh American Street Trac California ,.Stockfon, California Lodi, California Manteea, California Y. ES-9-2M Revised 6-'59 F.P.Co.