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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) This Permit Expires I Year From Date Issued Date Issued Application is hereby made to the Son 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 549 JOB ADDRESS AND LOCATION______44 S- ---------C_ • one-------------------------- ------------------------ ------ ------------------------------- -----: one--------------------------_ Owner's Name-------------- ....... Address_..----...... ------ ---------------- - — ------------------------ -------------- ........... Contractor's Name ----------- ------ ---- PhO4�� Installation will serve: Residence K Apartment House [] Commercial L] Trailer Court [] Motel Ej Other L] Number of living units. --- umber of bedrooms _-Z-gurn6er of baths -------- Lot size ---X6�--------?.......o52;7------------------- Water Supply: Public.system Community system El Private [—] Depth to Water Table _06t. Character of soil to a depth X3 feet: Sand ❑E] Gravel ❑E] Sandy Loam E] Clay Loam E] Clay F] Adobe Hardpan C] Previous Application Made: Yes E] No E] New Construction-: Yes E] No E] FHA/VA. Yes E] No Ej tt TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p#ic sewe,r is available within 200 feet.) Sept' Tank: Distance fi�om nearest well__/VOADistance from foundation-----/0---------Material-------B No. of compartments--------2------------Size_6-,T.]ii�____._Liq-id depth_._-_- Capacity----f?Q--- Disposal Field- Distance from nearest w 11 ;_k,#7zt_Distance from foundation(_/.0--`-____.Distance to neareslot lint_-_____. Number of lines Length of each I i 1112-.Width of trench____.,,_______________ Type of filter ma`feriaI_r,_?_______ Depth of filter material___)e-------- ----Total length---------2r________________________ Distance to nearest well-7 DistanceA��•rze: d'afion--4,1-'O--..-.--..Distance,,;�o nearest lot line ___—�---------- Seepage Pit: 1 1 Dept -------------------- Number of pits------- --------------Lining material---1 Diameter i--- Cesspool: Distance fi:om nearest well-----------------Distance from foundation--------------.-----Lining materia!_____:__________-_____________-_____ ❑ aterial-----:------------------------------- F1 Size: Diameter-------------------------------------Depth......---------------------- -------- -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest weli----------------------:----------- --------------Distance from nearest building--_____--__--__-_-_-___-____-__-----__.._. ❑ Distance u;Iding------------------------------------------ Distance to nearest lot line _.--------------- -------------------- ------------ ------- ---------------------------------------------------------------------- - Remodeling and/or repairing (describe):--------------------------------- ---------------------------I----------------------------------- --------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------f------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------- .......... I hereby certify that I have prepar this appliq tion and that the work will be done in accordance with San Joaquin County ordinances, State laws,/;ny rule and regulation the San Joaquin Local Health District; [Signed----------------- ------- ------ -- --- -- �>/o� rContractor) -- -------- (Plot plan, showing size of lot, location of s min relation-towe Is, buildings e C., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- X _ -------------------------- --- ---------------------------- DATE &_, 0- - REVIEWED BY----------------- --------------------------- I -- - DATE-- -------------- --- -- BUILDING PERMIT ISSUED------------------------------------------------------------- -- - - -------- DATE---------------------------------- -- ----------------------------------- - Alterations and/or rec mipegdafions. -------------- --------------------------------------------------------------------------------------------- �R------ ------------'A, -------------------------------------------------------------- -------------------------- -- -----m-- -- -----I----------- - -- -- -------------------- ---- --- - -------------- ------------------------------------- ---------- ------ ---- ------------? -------------------------- ---- -- e__f -_0--------------------------------------------- ----- --------- ------------------- ----------------------------- #; ----------------------------------------------------------------------------------------- - --- -- ----- -------------------------------- FINAL INSPECTION BY,.,_�_ --- - --------- Date--------- ------ ---- ----------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT M South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M Revised V59 F.P.Co.