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APPLICATION FOR SANITATION PERMIT Permit No. .-2-.3_�.-2 (Complete in Duplicate) i `-'�' j This Permit Ex ires 1 Year From Date Issued Date Issued -`-:_"/C --_{- Application is hereby made to the San Joaquin Local Health District for a permit to construct and in ill-,the "r herein described. This application is made in compliance with County Ordinance No. 549. v "� JOB ADDRESS AND LOCATION , r ' .la- alt ---- Owner's Name----- - w j c� � s� * • �� - - Phone� 1 3 6 Contractor's Name-� sl -------•-----•--- -__-- - - --- ------ - --- ---�-�---�----�-- -�-�-- - -------�- ---�------ -�-�------ -�- - �- Phone-_-•------------ Installation will serve: Residence)&&]nj Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms J_ Number of baths :1�.. Lot size Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. aif e Y'44sk=` . • Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan y"❑ Previous Application Made: Yes ❑ No ❑ Now Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 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-:9U_'------Distanc fro foundation--/U-�- -_ Material 06 No. of compartments-.-�----------- Size 7r' .- ---Liquid depth_----- ---- - ------- ___Capacity-� --- p ------- isposal Field: Distance from nearest well-_L-G' _ --Distance from foundation----/C---------Distance to nearest lot line--- - _.----- Number of hnes- Length of each line- �1 `-------.Width of trench--- _ -'! Type of filter maferia f -- ' �,r i --Depth of filfier material---.IR- -------Total length--Z-7-d Seepage Pit: Distance to nearest well---------- ---------_Distance from foundation-----------------.-Distance to nearest lot line F-1Number of pits------------- ------Lining material------_-__----------- Size: Diameter.----------------- - ---- Depth ----------__...__..--___ Cesspool: Distance from nearest well.------._--_. .Distf ------- Distance foundation----- Lining material -- -- ----- ❑ Size: Diameter--------------- ------ ------ Depth -- ----- ----------------- ---------- -----"------------ Privy: Distance from nearest welt - Liquid Capacity--- -----------------------gals. _--_---------------- El Distance from nearest building Distance to nearest lot line---------------------- -- - - ..--�- ----------- -------- -- ----- ------------------•- --- --- ------------ - -------------- Remodeling and/or repairing (describe)----------------- - ------ ------------------------------------------------- ------• ------------------------------------------------------------------------------ ------------------"------------ - --.. -- -- 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 ru,s and ula ions of the San Joaquin Local Health District. (Signed)-------Y f t B ------ --------------- ----(Owner and/or Contractor) Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). -------------------------------------------- wells, - ----(Title) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--- REVIEWED _- x_e. -------------- DATE ------- DATE-- -------- - BY --------- ----�- - �- - -. --- ------- DATE---------------------------- BUILDING PERMIT ISSUED -------------- ----------------------- - ------------------------------------------- .._ - ---- ---------- ---------------- -------------------------------------------- DATE - Alterations and/or recommendations,-------------- ------ - --------- ------ - -- ----- rr+-- - ------ - FINAL INSPECTION BY. y --- Date_ r -- ----------------- 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—?.M R d 8-'59 F,P.Co.