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APPLICATION FOR SANITATION PERMIT Permit No. ..1. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .ll..00 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 compliance with County Ordinance No. 549, II,, JOB ADDRESS AND LOCATI /N---•---_- �1 e —.---------- Owner's Name-------•------------ Gam--. - Jl - - -•Phone. _ - ----�--�-�-------- -----�---------------- --- ----------- - -- (� -sir-----�_�-'-��' Address_.... ----------------�7• ---Q -- 5 -! - C�c /v. ---------------------- Contractor's Name0"CI- --------------------------------------------------•--------------- Phone--------------• - - ._ -------------- Installation will serve: Residence X Apartment House [ Commercial ❑ TFailer Court ❑'"Motel ❑ Other 0 Number of living units. __ __ Number of bedrooms Number of baths - +-_ Lot size _____. ---r ''.--/s..s7 --------- Water Supply: Public system ❑ Community system ❑ PrivateX Depth to;Water Table -------- ft. Character of soil to.a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam � Clay � Aclobeg Hardpan E] Previous Application Made: Yes ❑ No New Construction: Yes No ,� � ❑ FHA/VA: Yes ❑j' No)< � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee#.} , `^1 'v Septic Tank: Distance from nearest well_-__-0�__Distance from foundation'_._ C _ --E .Materia i_.__� - No. of cam artments_____-- - 1 I / p Size x"� -� Liquid depth--------y -------..Capacity-, Disposal Field: Distance from nearest w 5U._ _Distance from foundatio -.�-CI__�k..Distance to nearest lot line...... Number of lines_______________ -_ .__ Length of each lin g f �-C6--Width of trench------- Type of filter material--- _-Depth of filter material--I-__'__V8- Total length------------ f '----------------- Seepage Pit: Distance to nearest well_______'______________Distance from foundation,___---------------Distance to nearest lot line_______-_.._-__ Number of Cesspool: Distance fr mtsnearest well- Lining mDistanlce from foundation------ tie aLinin atter�t�____________ _ _________~- -. ._g - �. Size: Diameter--------------------------------------Depth-------------------------------- -Li uiti.Ga a l q , , PVW,ty-- -------gats. Privy: Distance from nearest well________-_---------------------------------------Distance from�`n ayes i-building Distance to nearest lot line______________.._______ ---------------------------------------------------------------- i Remodeling and/or repairing (describe)--------------------------------------------------------------- I - ------=----------------------------•------------------------------------ --- ------------------------------------------------------------------ ----------------- ------------------ ------------------------------------- -----------------I-------------------- I { - -------- ----------------------------------- i ------------------------- c hereby certify that I, have prepared this application and that the work will be done in accordance wifh.San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �j B - (OwnerContractor )----------- ----------------(Signed) -------------- Y -----------------------------------------•--------------------------------------------------------------- -------- ---------(Tif le)---------------------------- -------------- - -- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc; can be placed on reverse side). FOR DEP T NT USE ONLY, APPLICATION ACCEPTED BY -'; DATE_. -1-.2 ------------- - REVIEWED BY ------ --- --------------- - ------ DATE---------------- BUILDING PERMIT ISSUED---------------------- ----------------------------w--------------------------- ---------- DATE - - ------------------------ terations and/or recommendations________________ _ ----------------------- ------•---------------------------------------- ------------------- -------------------------------------------•-----------•------------------------------------------------------------------- --------------------------- --------------------------------------------------------- =---------------- ------:------------------------------ FINAL INSPECTION BY:. „. ------ Date------ ---------&-- ,:a2. _ -------- ------------------ --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 13d"Soufh American Street 30o 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.Co.