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3 0 -1t' APPLICATION FOR SANITATION PERMIT Permit No. .. ..a..� (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. k This application is made in compliance with County Ordinance No. 549. 7 t f f JOB ADDRESS AND LOCATkON.. ____�_______ � �f�` Owner's Name------- f f -'----- - - -,-•---------------------••------------'----------------------------------------- ---------- Phone,_ .. •3.. ----r.) �fT •-- Contractor's Name . , � --- Phon /---Address-----•----- --. Installation will serve: Residence partment'House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J- Number of bedrooms - __ Number'of baths - _ "Lot size _ r _S___ _� C�___________----------- � 1 A , Water Supply: Public system E] Community system ❑ Private 2�, epth4to Water Table � S_ ft. Character of soil to a depth of 3 feet:'Sand ❑ Gravel ❑ Sandy Loam 0. Clay Loam ❑ ,Clay ❑r Adobe Hardpan ❑ Previous Application Made: Yes ❑ .No ❑ New Construction: Yes No ❑: FHA/VA: Yes L] No ❑, TYPE OF INSTALLATION AND SPECIFICATIONS: ! f -(No-•septic tank or cesspool permitted if public sewer is available within,200.feet.) if� �.. �- Septic Tank: Distance from nearest well_,.,1�_.______Distance f m foundation-__ Fp /P. Mated No. of compartments-----�----------- ---Size-_�_6 -------Liquid dept-----y t ------Capaci�� p- bisposal F Id: Distance from nearest,well_��-_--------.Distance from foundat on----,1�_----,.�3istance to nearest lot lme----_______.� - Number of lines__________ _____. ..____ ._ Length of each lineo _____S!Q__-3 S._.Width of trench_____ _,r,�_.___-.______.____ - 6._ e, • Type of filter material- __ _.___Depth of filter material__f .___________Total length-----/47V:______________________ x r . ------------- e age Pit: Distance to nearest well-----_--------_________D+stance from foundation_____ '_____..Distance to nearesf lot line_ _- of pits--.-----=ir___- Lining ;materials--r___-.--_R-----Size: Diameter---=�-------"-----_.Depth--------------------------- Number � " Cessp Distance from nearest well_________________Distance from foundation"""'__ _dining material-------------------------------------- Size: __,_- _-____.________.____.______.Size: Diameter---------------- --------------------Depth-----------='-----M ---------------------------- Liquid Capacity -----....gals. �. Privy: Distance',from nearest well---------_____-"`_______.______._��`-""'_._Distance from nearest building..---------------------------------------- k ❑ Distance-to nearest lot like _____________ --- - J ------------ -- I ' ` — ---- ------------------------- and/oodeling --------------------- ---------- -- ---- 1.1 ar I hereby trtify that I have pr d this application and that the work will be done in accordance with San Joaquin County I ordinances, t� laws d rule re ulations the San Joa 1 .Local Health District. .A i �ner and or Contractor[Signed} - - ) __ _____1_ .. By:----------------------------------------------- := = -- -------- (Plot tr+lei (Piot plan, showing size of lot, location of system in relation to 4w Ildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------{ ►---- - ---- -------- - ----------------------------------- DATE--- --------------- �7 Y . BY------------------------ ------------------ ----------"------------------------------ ---------1-%--••-----------------`-`:_.: DATE----------------------------------- BUILDING --�---------- ' BUILDINGPERMIT ISSUED-------------------------------- -----------=---------—--------------- ---------------- DATE---------------------- = Alter tions and/or recommendations _ f ---�=f--�- �= = 1_ . � _________ _ _______ _.._._________ Ej--- �� G+ - n = _ - _ r FINAL INSPECTION BY:---- rf� -fC :--- --- Date------- ...... ------------------------ f/ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 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.CD.