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y ( APPLICATION FOR SANITATION PERMIT Permit No: -!_ (Complete ih Duplicate) I // This Permit Expires 1 Year From Date Issued Date Issued -------1,(_7/&0 -_-- 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 LOCATION_______ _ Owner's Name---------- �1 1== (_- - -----. Phone 1 -.. !!! + Address--------------------------- ----------•- j\ Contractor's Name---------`'' ' >--_--------------- =•------------------- ------------- Phone----------------------------------- _ _ ----- ------- ------------•-•-•- - Installation will serve: ResidenceJ Apartment House.Elm Comercial E] Trailer Court ❑ Motel [D Other Ai Number of livingunits:/---- Number of bedrooms_ Number of baths _- -- ------ ---------------••------- Water Supply: Public system Community system ❑ Private-.[I__Depth to Water Table------ I x Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe�i Hardpan ❑ l / Previous Application Made: Yes ❑ No! New construction YesV.[�-•-•No..�. • FHA%VA: Yes ❑ NotA TYPE OF INSTALLATION AND SPECIFICATIONS: !1 1 �' k (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r R Septic Tank: '' Distance from nearest well_________________Distance from foundation---------.----------Material- ____________--_-_____._________-.._____. ❑ No. of compartments Size --------=-== ------ ----Liquid depth ;Capacity ------------ Disposal Field: Distance from nearest well-_ ~-- ____Distance from #o`undation...__f__ Distance to nearest lot ine_ _G a MNumber of lines- ----- --------------- Length,of each line---------6G_`-_ Width of trench.------,2--Y------------------- r {T Type of filter material____ Depth of filter material-_____ :_____.._Total length------_-- -- Seepage Pit:r Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line_____---......... ❑ Number of pits--°-------------------Lining material-_---------_----------Size: Diameter---------------....-_Depth-------------------------------- ❑ Size: Diameter_ Barest well-----------------Distance from foundation___________________ Lining material__.__---__._______.__.__-________.__. ( -- - Depth - ---------- Liquid Capacity gals. ass oo: Distance from n Privy: Distance from nearest~well-----------------------------------.-------------Distance from nearest buil&n _ # ❑ Distance to nearest lot line = _ =-- --- ---------------------------------------•---------••------- Remodeling and/or repairing (describe)_-----------------------------------------------------.------ ---------r----------- ------------- ----- - ------------------------------------•-----------------------------------•------•-•--- ------------------•---------------._.---------- ----------------------------------------------------------------------- -------------..-,_ I hereby certify that I h"eve prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State aws, ynd rul and r gulations of the'San Joaquin Local Health District. (Signed) -- --------- ---- (Owner------=--=------------------------------------------------------(Ow and/or Contractor) BY: -------- ---------------------------- -----------------------------------------(Title) ---------------------------------- lot,plan, showing size ofslot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I to m� - — j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- R Q " - ------------------ DATE ------------ REVIEWED BY-------------------------------------------- -------------------------------------------------------------------------------- DATE------- BUILDINGPERMIT ISSUED-------------------------------- ------------------------------------------------- ------------------ DATE------------------------------ Alterations and/or recommendations:__.___..__._-_ --------------------------------------- ----------•-------•----------------- ------------------------------------------------- ----- --------•----------------------------------------------------------------------- ------------------------------•------------------------_-------------•---------------------------------- -----------I------------------------------------ _ __ ----------- __ 5T - �--------- ----- u: - ------ ------- 4 � e ::::::: ti e.- 1,7 :s.. FINAL INSPECTION BY:.- --------------------- Date ----------------------------- `t' SAN JOAQUIN LOCAL HEALTH DISTRICT , 130 South American Street 300 West Calc Street 132 Sycamore Straot 814 North "C" Street Stack+on, California Lodi, California Manteca, California Tracy, California ES41-2M Revised 8-'59 F.P.CC. -