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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) This Permit Expires I Year From Date Issued Permit No. 2 1 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. f -I( JOB ADDRESS AND LO ATI 570 A --- 144 ---------------------- t - Owner's Name ------------ - I --- ---- % W ? 4 6? -,t - ------------------------------------------------ ------- - ------- Phone-- X-� Address---------------- -1-!- ...... Contractor's Name------------- -------- A, --------- Phone ................. ----------------- Installation will serve: Residence & Apartment House ❑ Commercial E] Trailer Court E] Motel 0 Other ❑ Number of IV4. units: -------- Number Of bedrooms Number of baths -- Lot size ---------- ....... Water Supply: Public system E] Community system; 4Mfe W Depth to Water Table -50ft. iI I Character of soil to a depth of 3 feet: Sand',,Ej Gravel E] Sandy Loam E] Clay Loam [] Clay E] Adobe Z Hardpan ❑ Previous Application Made: Yes [-] NoNew Construction: Yes [�o ❑ FHA/VA: Yes E] No Po" I Del TYPE OF INSTALLATION AND SPECIFICATIONS: IF ift'k � (No septic fankor cesspool Perm edt- if puyic sewer is available within 200 feet.) Septic Tank: Distance from nearest well-544-Disfancl from fOLIndVion-/P-tiKl-PL!-.Mafer�1 aI ------- tcced-w --------------------------- No. of compartments------- ..... .. *- SizJ---'3-1-1-?- ---- Liquid clepth -------- lYt------------ I Capacity ----- Disposal Field; Distance from nearest well -/-9-5 -------- Distance -from founclationjo-hlk�.. Distance to nearest lot Number of lines-- P0 � k A X ----------- Leqth of,each-line ------- 9-0 .... ... . ___..Width of trench----- --------------- Ty � of filter material----- ---- pth of filter material___--- . . ..... Total length_ �__________-_ Seepage Pit: pie 5c �- 1� I Distance to nearest well___________________ _ Distance from foundation ------------- .-----.Distance to nearest lot line_.___.___._______ ! ❑ ine----------------- El Number of pifs ---------------------- Lin'TiT9 - ma te r i 61 ----------------------- Size: Diameter----_------------------ Depth------------.--------------....-- Cesspool: Distance fi-cm nearest well------------- ---- D -s-tance from foundation -------------------- Lining material-...__-__❑ ----------------- Size: Diameter-------------------------------- ---- Depth -------- ------------------------------------------Liquid Capacif ----------------------------gals. y Privy: Distance from nearest well_____.____--____________ _-______.___Distance from nearest building_.__________________________________ ❑ Distance uilding------------------------ Disfance to nearest lot line --------------1- ---------------- -- ---------------------------------- ------------------------ riring (describe): --- Remodeling and/or rel ------ ---------------------- ----------------------- ----------------- ---------------------------------- ---------------------------------------- ------------------------- -------------------- --------- :: ------- ------ ---- -------------------------------------------------------------------- --------------- i --------------- ---------------------------------------- ---------------------------------------------------- ---------------- ----------------------------------------------------------------- --- --------- 1, I hereby certify that I have prepared this applicaii1on'and that the work will be done in accordance with San Joaquin County ordinances, State laws, "and rules and regulations of the San Joaquin Local Health District. t ()Signed----------------------------------------------------------------- (Owner and/or Contractor), ----- x ------- C -------- BY - I. --- ------------------------------------------------------------------------------------------------------------ (Tif le) -------------------------- -------------------- ------------ F (Plot plan, showing size of lot, location of system in relation to�.weIls, buildings, etc., can beplacedon reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------- ----- eL7 -r- \ ii � \ ------ --------- DATE --------------- - ------ 2- ---------------- REVIEWED BY------------------------------------------------------ ------- ------------------ DATE ------------ --------- BUILDING PERMIT ISSUED ------------------------------- ------ ------------ ------- - -------------------------------------- DATE ------------------------------ Alterations and/or recommendations: ------------ w -------------------------- ----------------------------------------------------------------------------------------------------------------------- -- ---------------------------------------------------------------------- -------- ------------------------------------------------------------------------------------------ --------------------------------------------- ---------------------------------------------------------------- ------------ ------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------- --------- ----------------------------------------- ------------------------------------------------------------ ----------------------------------- ----------------- --- ---------------------------- ------ ---------------'-e---------------------------- ------- ---------------- ---------•------- -----�- --'------ -------------------------------------------------------- FINAL INSPECTION BY%&—C"WV 14W Date----�--/- — /-- ---- 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 6-9-2M Revised 8-'59 FT.Co.