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_ A APPLICATION FOR SANITATION PERMIT'. Permit No. ------ --- � (Complete in Duplicate) N 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. This application is made in compliance with County Ordinance No. 549. _�___._ --------------------------------------------------------------------_.-.------------ JOB ADDRESS AND L QATION____ -- Owner's NameY----_&Y27C-------------------------------------- Phone ------------------------------------ ---------------------------- Address........ -- •------------------------------------------------------------------------------ Contractor's Name-------------------- _ __ Phone ___________________-. Installation will serve: Residence @?"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other L❑ Number of living units: Number of bedrooms _z__ Number;of baths __/___ Lot size_,(,_.��__`________________________ Water Supply: Public system 'Community system ❑ Private ❑ Depth to Water Table �OTft. Character of soil to a depth of 3 feet: Sand ❑ —Gravel ❑ Sandy. Loam ❑ Clay Loam ❑ Clay ❑ Adobe P9--5ardpan ❑ Previous Application Made: Yes ❑ No UP-- New Construction: Yes ❑ No FHA/VA: Yes ❑ No Rg.— 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 ----------------- Distance from foundation -------------------- Material______________ -__-___-_____-_-_____--_--_______. No. of compartments------ ------------------- Size ----------------------------: --- Liquid depth -------------------------- Capacity ----------------------- fDisposal Field: Distance from nearest well... -_Y' -_._._.Distance from found ation__�!1___________Distance to nearest lot line__fa-.___ Number of'lines__________ ___- Length of each line _______'�.0__:!__'...... Width of trench-.-. -_!� _ ... � ' Type of filter material_ ____<__ Ip -Depth of filter material __1.r&`�____--Total length=:_/E� . �.F ___f Distance to nearest well -------- fro foundation___:' _ _ - Seepage�Pit: a______.D�stanc to.nearest lot lin *_____ �;,F Size: ,Diameter____. __ Number of pits - ------- - ------------Lining material__-- -- _ _ _ �17-- - --Depth----A-11�-------____-- Cesspool: Distance from nearest well ----------------- Distance from foundation ___._-_-________--.Lining material --------------- _---__-____-_-___--_. ' ❑ �k— Size: Diameter -------------------------------------- Depth ------------------------------------------- Liquid Capacity ---------------------------- gals. Privy:. „- Distance from nearest well ------------------------------------------------- Distance from nearest;building---------- ❑ Distance to nearest lot line_--.__-_ rr. ° ` t - --- ------------ Remodeling and/or repairing (descriI3d):'°__7'__"___* s ' --------------------------------------•-------------—_----.---------------------,-------------------._--------- — --.--------------------•---------------------. --------------------------------------- -----------------------------------------------------------------------------------•------------------------------------•------------------------------------------------------- ---- --- 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, andRrules a d regulations o the San Joaquin Local Health District. (Signed) ---------------- ------------------------------------------(9ae.or Contractor) - r B Y• j _(Title)_ (Plot plan, showing size of lot, location stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ---------------------------------- DATE -- — c? -----------'------•--------------------------- REVIEWEDBY----------------------------------------------------------------- -------------------------------------------------------- DATE.------------------- -------------------------------•------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------------------------------------ DATE--------------------------- ------------ ----------- -------- Alterationsand/or recommendations------- ---- ------ -------------------------------------------------- ----------------------••--------------------------------•-----------------------•------- ---------------- ---------—---------------- -- -- ----------------•-------•--------•-------- - ------------------- -"/ ------- - t--�-------------------------------------------------- ---------------- ------------------------------------- ------------------------------------------------------------------------------- ----------- -------------------------------------- FINAL INSPECTION BY:-.-.- - Date - ---- T l U rC`'------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California 1 >; '.an ece, Manteca, California Tracy, California ES -9-2M RevEsed 8-'59 FP.Co.