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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ___/// This Permit Expires 1 Year From Date Issued �s9 Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This.application is made.,in.compliance-with County Ordinance No. 549. �,� [-.Yl/•dL/ELKi9- .[rXZ' > JOB ADDRESS AND LOCATIO ' �-----),-14?Owner's Name ---�TV -: _ Phone__... /� -------------- Contractor's Name--------- -------------------------- `---------------------------------------------------------------. Phone------------------ ---------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` Number of living units: __Z__ Number of bedrooms:_. Number of baths -l._- Lot size -_-______---_________-_ E ' Water Supply: Public system E] Community system Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel,E] Sandy Loam g3---Clay Loam ❑ Clay [:] Adobe ❑ Hardpan ❑ - Previous Application Made: Yes F1No New Construction: Yes PD--No ❑ FHA/VA: Yes EJ'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'-----_--Distance from foundation--_/10_-______-Mate,Tial----- _ _4t1w-1------ No. of compartments-_ -s----------------Size-s1�_J'h'9--______Liquid depth---��---.-.-__. Capacity_._��/______; � Disposal Field: Distance from nearest well----- -- ------- from foundation-_��_--_____-Distance•to nearest lot line--��---.-__ 0� J 9 ` Tlu e of filter material- Depth of f filter each �___`____:otalthlenf length nch � ----------------------- Type --- _____--ti_-l--Y Yp --_---_Distance from foundation __ _ _ _____Dis nce gto nearest lot line._.__._. ...-__.-. ' Seepage Pit: Distance to nearest well_--_____ !g �� } [ � Number of pits~�;�----__ Linin material_-- 1*1- .Size. Diameter----��j��frDe th-... P Size: Diameter-_-z �------------------------De th--------------------------------_----------_____---_Liquid Capacity-. ak Cess ool: Distance f:om nearest well_________________Distance from foundation-------------------- material_.__----__-_---._-_----________ El Distance from st Privy: Distance to nearestelot linle--------------------- ------------ -------___ Distance from nearest building----------=Y_----.---=________:--_.___--__I ^t ❑ r Remodeling and/or repairing ,(describe):----------- -- -------- ------------------------------------------------------ --------------- -------------------------------------------------------- ----------------------------------------------------------------------------------=---------•--•------------------------------ -------------------------------------=---------------------------------- ----------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this applicat 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. (O►yer_- Contractor) (Signed) 4 _ BY- -•-------------------------------------- _ '-_ (Title} /C�/_ (Plot plan, showing size of lot, location ofd stem in relation to wells buildings, etc., can be-placed-on-reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY--------- --- ------------------------------------------------------------------------------------ DATE---------f--- ------------- ---------------- 1 �` REVIEWED BY---------------------------------------------------------- ------- , ---- ------__----- DATE----- - I BUILDING PERMIT ISSUED------------- --- ----------- ---------.-y DATE------------ -------------------- ----------------------• Alterations and/or recommendations:----------------------------------------------------------------------------------------3. -------------------------------•--------------------•--------:-------- ----------------------------------- y -- ------------------------------------------- ' ----------•---------- --- -------------=- ------------------------------------------------------------------------------------- -- -•---------- ---------------------------- --------------------------- --------- , 1 , ------------------------------------------------------------- -- -------------------------- --------------------------------------------------- ---------- ----------------------------------------------- ----------------- 1.11 --------------------------------------- --------------- --------- -- FINAL INSPECTION BY------------------ -- -W-----------�--------- Date.------------/I--r-f- ---------------------------- - 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore St eet 814 North "C" Street Stockton, California Lodi, California Manteca,�California } Tracy, California f' E5-9-2M Revised 8-'59 F.P-Co- } • i _i• � 1