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FOR OFFICE USE: . --'-------------------- 4- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) I ----- This Permit Expires 1 Year From Date Issued Date Issued ... Application is hereby made to the San Joaquin Local Health District for a permit to const Fuct and install the work herein described. This application is made in compliance with County Ordinance No. 549.ir JOB ADDRESS AND CA ION._ � . Owner's Name-. :fes �- ez ......,e.e -�. .... _ . . Ph ............. Address /f �j ,(.e� �Y/yL��2l F L -------------- ----------------------------------------.-......... ----- -- Contractor's Name_&-.+ .r.1Cl` _y. .,f(�. — ' 3--•------•--------------- Phone . _ Installation will serve: Residence A--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- bar of bedroomi--5- Number of baths J-.- Lot size .....�� _ "60-1---- -------- Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table -6oft. Character of soil to a depth of 3 #ee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [],,Adobe ardpan ❑ Previous Application Made: (If yes,date--------------- ----) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ �F INSTALLATION AND SPECIFICATIONS: [No se . ank or cesspool permitted if public sewer is available within 200 feet.) Se tic T nk: Distance from nearest well-----------------Distance from foundation-------------------Material------_.-......---___._.........-..--._......... No. of compartments.. -- --------- ize--------------------------------Liquid del? h---------------- ----Capacity--------•---•----- pos iold: Distance from nearest well_6 Distance from foundation_-_- ---------Distance to nearest lot line_ . -._..r 1 f Number of lines-__-_-� 4i� --Length of each IUne.-�0----!---------.Width of trench." ......_... _Type of filter mafierial. ��1 r Depth of filter material------ -- -----------Total length--------------•-••--.--�. -.-___--- S age ,i Distance to nearest well-- - -...Distance tom foundation___.. ........ � nearest lot line..... .......... Number of pits...___---------------Lining material--Kar �0un--d- afion- , Size: Diameter_--�--_--Depth--_-2--' ---------------- Cesspool: --•--------- • Cesspool: Distance from nearest well-.---------------Distance from _______________ Lining material.---.--------------------------------- 171 ----..-.-_---_------_.-_ ❑ Size: Diameter.- -- - --- --_.- - - ,.Depth---- --- - ------- ------------------------ Liquid Capacity- •----------------------gals. Privy: Distance from nearest well----------------------- - ------- - --.-.Distance from nearest building------------------------...._. ❑ Distance to nearest Tot line-------------- Remodeling and/or repairing (describe)------- ----------- -- - - ----------------------------- --------------------- - -- - --- ----- - -------------------------------- ------------------------ ----------------------- -------------------------------- ------------------ --------------------------------------------------- --------------- -------------- I hereby certify that I have prepared this application and that the work wil 6e done in accordance with San Joaquin County ordinances, State a d rules and regulations of the San Joaquin l Health District. e n r Contractor) By---------------------------------------------------------- -------- - -------------------- - {Title]p (Plot plan, showing size of lot, location of system in relation to ells, buildin s, e c can 6e laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY / a r'f �': - - ------ ------------------------ DATE_ �: REVIEWEDBY- ----------------------- ------------ ------------------------------------• DATE ------------------------ -----• ---- 1 DING PERMIT ISSUED DATE,-------------------------------- ---- Atterations arid/or rec - - `Y r�tenda#ions . t_. --------------------------- ---- r. FINAL INSPECTION BY:... .f '" - Date..... :- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-62 ATLAS