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APPLICATION FOR SANITATION PERMIT Permit No. ...�.. .-3..� (Complete in Duplicate) �� {� This Per Ex ires I Year From Date Issued Date Issued .___- - ��ror—oZ Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta I the work herein described. This application is-made in;compliance-with,County Ordinance.No..549.._- JOB ADDRESS ANP_�OCATION._ Owner's",N' �f�iiL �6llesl [t_ fi�9�!'rf -------------------- --------- -------- Phone------------------------------------ Address-2-------- � -ay----•.. ------4s ,T ----------------------------------- Contractor's Name � Installation will serve: Residence ❑ Apartment Douse ❑ Commercial Trailer Court ❑ Motel ❑ Other Number of living units: :_______ Number of bedrooms -------- Number of baths ________ Lot size _�_�fc+G�t�---- _- Water SuPPIY� Publicsystem ❑ CommunitY system Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravelk❑ ' Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes 011 No New Construction: Yes FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: `'A*.septic +a;k or cesspool permitted if public sewer is available within 200 feet.) ep#ic T�nk', Distance from nearest well_1.__;_--_______Distance"from foundation___________________.Ma#erial -----------------------------.r.ro_ No. of compartments--------------------------Size------------------------------Liquid depth----_- - ------ Capacity------------ --;, isposal'field: Distance from nearest well.S ---.--------Distance from foundation__/0-_.__.......Distance to nearest lot li �� ---------- Number of lines _____l___ ____________________Length of each line------ of trench_---- _ e-1 -_ _-.------_._ Type of filter material__ _,' ____________Depth of filter material_____� p _ Total length-------- ---------------------C . C Seep g,Pith / Distance to nearest well__1OQ- /p ►f7�19 _._______Distance��m foundation___��_.�_.____.Dis ante to nearest lot line_ -�_�__.. 1 �xf Number of pits_ - --------------Lining material____!?.Q_� ---Size: Diameter---- D �r-------Depth....r� _�------------- t Cesspool: Distance fiom nearest well-----------------Distance from foundation-------------------Luning material-------------------------------------- ❑ Size: Diameter___1.__.______________ --------------Depth--------------------- ---- Liquid Capacity- --------------------------gals. Privy: well 'i Distance from nearest well__________________ ___________________________._Distance from nearest building----------------------------------------- ElDistance to nearest lot line ----------------- t _ �j� Remodeling and/or repairing (des`er]be)------ --------- -- ---- -------- `-----�---- --- ----------- -- ----- -- , ---- 1 -y- - - � i - --------- -- -- --------------------------------------------- ----------------------------------------------- ----------------- ----------- i 1 hereby certif that I have prep this application and that the work will be done in accordance with San Joaquin County San Joaqui .'.ocal Health District. j ordinances, Stat awx, and es a re lations o the (Signed) --- � {Owner and/or Contractor) BY ; ------ ------------- -(Title) h {Plot plan, showing size of lot, location o �n relation to wells, buil i gs, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY --------------------- � ` -- DATE- q -------------------- REV fEWED BY------------------------------------------------------------------------------------------------ ----------------------------- DATE---------- ------------------------------ UILDIN PERMIT ISSUED-------•----------------------------------------------------------------------------------- --------- DATE- ------------------- --------------------------------------- Alterations and/or recommendations:.---- --------------- ------------- ---------------------------------------------------------------------------------------------------------------------------------------------- yy FINAL INSPECTION BYc' �71;7------- - -------------- -------------- Date-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Sao West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.P.eo. _