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APPLICATION FOR SANITATION PERMIT Permit No. _-_!-.�_3 4:6 IL (Complete in Duplicate) This Permit Expires I Year From Date Issued Date issued ___�/�y�r_�--o 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. JOB ADDRESS AND LO ATION__.'------- -.Z- - ----- �+ - - Owner's Name-------- -- ------•-----------•---•--- ----------- ----------------------------- Phone_/-i Address-----------••-----------*Z ¢1-�-'----•---------��.-------- ----------------••-------------------------------------------------------------- Contractor's Name_____________ _ --------------------•-------•----- ------------•-- ----------•--------•----•---------------------- Phone Installation will serve: Residence Apartment House E] Commercial E] Trailer Court ❑ Motel E❑ Other ❑ Number of living units: Number of bedrooms ._Number of baths -_-f_ Lot size __l ._ '-- •- r --------- Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table -------- ff. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay Loam Ej Clay L9 Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No {X New Construction: Yes ❑ No FHA/VA: Yes ❑ No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---------\'�*.Dlsfance from foundation---- --- _-_---___-______-Material _______________ -----------compartments----- -------- Siz _=--r*------------ ---------Liquid depth--------------------------Capacity--•--- -- ------------- Disposal3Field:i Distance from nearest well_...._� _,_.,Distance4£rom foundation,._ p__.____ r __ Distance to nearest lot line______ -n• ;Number of lines________________ Len -th of each line__---_ �-� _y----------------Width of trench- --------�---- - ----- T,ype.of filler material____-�----Depth oYfilter material__________ __________Total length g _-=-¢--------- Seepage Pit: Distance to nearest well___-_____ __-____`_Distance fr m foundation__�.-c�_-____-Distance to nearest lot line-------Ir- f L4' Number of pits...... -----------`Lihingt material-- ' _ -.-Size: ......� Diameter � -- -------.,Depth-----�•-�Cesspool: --1-- •----------- �' Distance from nearest we.11_________________Distance from�oundation___._._________-___.Lining material___.__._._______________ \� ❑.. Size: Diameter--------------------- --------------------------------------- ------ � .Depth----------� Liquid Capacity-------------------- -----gal Privy: Distance from nearest well----__--____--_-_%-----_____ix-_--____--Distance from nearest building Distance to nearesfi lot —�_—_______-_____.� - Remodeling and/or repairing (describeJ:------------- i ------ �Y- 4� f 2 .,r_, --- - ------- - -- ----- ---- Z�: - ------------------------------------------------------•------------------------------------ ------- I hereby ertify that•f�have prepared-this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, rules and regulations of the San Joaquin Local Health District, {Sig" `' .. -'_ ---------------------- ( / --- -- - ----- _--_Owner and/or Contractor) Plot Ian:- oR . ----------- ------ --------•------------------------------------------------(Title)-------------------- ---------- j( p 'A' wing size of lot, I�cation of system in relation to wells, buildings, etc., can be placed on reverse side). j R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY,13 __- -_ ----- �---------------------------- BATE � � `"� REVIEWED BY ------------. =-------------------- ------------------ DATE-------- BUILDING PERMIT ISSUED-----' I --------------------------------- _ - 1 DATE Alterati ns an or recommendiations•---- _--- _r -,� . ' - . ---- ---7 C0 --------------e,�---- g:fp_ �^ ----------------------------------------------------------- FINAL INSPECTION `---------------------- ------------ Date--- rt-f - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streot 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 8-'59 F.?.Co.