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_ APPLICATION FOR SANITATION PERMIT ...Permit No. .. �.. d a (Complete in Duplicate) /d I This Permit Expires i Year From Date Issued Date Issued -__� + Application is hereby made to the San Joaquin Local Health District for a permit to construct ndnstal work herein described. This application is,made,in compliance.with County Ordinance No. 549. f `{ / JOB ADDRESS AND L CATION------- ArC4 -- ----- ------- ---------- Owner's Name------lJ_ = - -----------•---------•---------••----------------------------------------------------------------- Phone---------------------------------- Address----------q�l-r--- � Contractor's Name_ --- Phone----....__---------------------- Installation will serve: Residence Eq,"-A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-_l- Number of bedrooms _�_ Number of baths _1 Lot Size Q- lOQ----------------•-------------- I Water Supply: Public system Community system ❑ Private E] _.x /Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ef-IH-ardpan,❑ Previous Application Made: Yes ❑ No Q--�New Construction: Yes ®�No ❑ FHA/VA: Yes k�'- No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welf-----�--____Distance from foundation_..__la_______Materia!__.�__��_ A --------,I [ No. of compartments------�r--------------Size,1-4�-4(a---__-_Liquid depth_--- - (-----------Capacity.___Ipp --------- Disposal _----pisposal Field: Distance from nearest well----`�'_____.Distance from foundation___._��- _----Distance to nearest lot line__��_____... Number of lines._______ ..._ ____ Length of each line------�Q/--------------Width of trench.__�`._____.____-____-________--- -- Type of filter material---/ of filter material--__1f___.____Total length___._ E1---------------------- Seepage --___________________ See a e Pit: Distance to nearest well —-__ Distance fr m fo ndation___-Z P g -_-_ y P.......Distance to nearest lot line__`.-----_ Number of pits__.__/_-__________Lining mat erial__xPe .Size: Diameter---&—S".--------Depth___,2 `/________________ % Cesspool: Distance from nearest well-----------------Distance from foundation___________________Lining material-------------------------------------- pp ,E ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---•-----------------------gals.11 ( 3 Privy: Distance from nearest well------------------------------------------------- from nearest building- (a _- r.p ❑ Distance to nearest lot line -------------------- v Remodeling and/or repairing (describe) ��_ 'c�a�'r-`� ----------------- J�.. ------------------------------------------•--- =/ -- :_____._._ ' ---------------------------------- ---------------------- ---------------•-- •• --- ---------------------- --- ----------------------------------- ------------ 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.__ r (Signed)-,------------------ - r :�'- F - ---------------- c}for, Contractor] 11 By------------- ---- - -----•-----•-------------. --- �Inrel 1/ir! � -----------':---- ------------ (Plot plan, showing size of lot, location of s ation to wells, buildings, etc., can be placed on reverse side).; FOR DEPARTMENT USE ONLY 1 c - A` ✓_'"��-------------/- ' `�, ,Z C PATE J - ---------------- APPLICATION ACCEPTED BY--- REVIEWEDBY------------------ -------------------------- -----------------------------------------------------------------"-------------- DATE. BUILDING PERMIT ISSUED - ----- DATE---* =- Alterations and/or recommend ations-------------------------------------------------------------------------------------------------------- -- -- ---------- --- - ` - � - :, F-----:------_�----:-,--------------•------ 7 � _ FINAL INSPECTION BY-..6,"y., Lrte / Date------.. elf " SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-92N4 Revised 8-'59 F.P,Co. t