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11 r c '•1,1�� ►% APPLICATION FOR SANITATION PERMIT Permit No. .....f.,,/ (Complete in Duplicate) Date Issued This 7y (Complete 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. This application is made in com 1 p it County Ordinanc No,, 549- } '7 � JOB ADDRESS AND LOCATION______________ _ _______ __ F �--------- t F Phone_.. Owner's Name-------------------------------------- Address------------------------ -------- ;^ ------------------------------------------- -------•----------------•-•---. Phone�r1-_b Contractor's Name ..-� � Apartment House 171 Commercial ❑ Trailer Court [I Motel El Other ❑ installation will serve: Residence 9 A p _- Number of bedrooms Nbf baths __ __ umer o ,� / Number of living units: _� -__ tot size --(--�-- Water Supply: Public system Community system [I Private ❑- Depth to Water Table Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Application Made: Yes No w Construction: Yes ] No ❑ FHA/VA: Yes ❑ No,� Previous Applic ❑ TYPE•OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.} 10-------.Material------ Septic Tank: Distance from nearest well____ a ---_Distance rom foundation_____ Ca acit Size. �I7"r_ Liquid depth__��-�� P Y No. of compartments__--_ � -- f 4r� - Disposal Field: Distance from nearest well.- -___-_Distance from foundation_.-l.6____--___-Distance to nearest lot line_ _________ ____ Number of lines_______ ___ `_ _____Length of each line. 3 --- Width of trench_____ ,- -,-------------•- De tai of filter rr+ateriai_._- _ ------Total length___--- Type of filter material--- _ p Seepagei �S Distance to nearest well_____�a"---Distance from foundation_______- Distance to nearest lot line Number of pits--------eP___-------Lining material___---N- Depth--------- - _____ Cesspool: Distance from nearest well_.___-___.,___Distance,from foundation.----------- material____-_______________________________. ---De-th------------------------------------------------------Liquid Capacity--------------------- gals. \]\ ❑ Size: biometer = rp �3 Privy.. Distance from nearest well____-._----------------------------------------Distance from nearest building------------------------------------------ y: Distance to nearest lot line------------------------------- Remodeling and/or repairing (describe):------------------ ------------------------------------------------------- y -- ------ ..- •----------------------- -------------------------------------------- ------------------------------------------------ ---------------------------------------- ----------- { 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 rule .aad regulations of the San Joaquin Local Health District. (Signed) a - t : - (Owner and/or Contractor} 741 9 By: Title ------------------------------ - --- -------------------- (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-------------------- ------------°-------------------------------= DATE f� ... i - -- ------------------ DATE----------------- --------------- ------------------------ -------------------- =------------------------ BUILDINGPERMIT ISSUED- ------------------------------- -------------------------------------- DATE--------------------- Alterations and/or recommendations:-------------------------- -•-----------------------------------------'---------------------- -------- -------- - -------------------------------------------•-- ------- ------------------•-----------I--------------------- ----------------------------------------------------- ----- -------------------------------------------------------- '�j It CA I. FINAL INSPECTION BY:_ 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 FS-9-2M Revised 8-'59 F.P.Co.