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,/ SANITATION PERMIT Permit No. . a I (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued .`OJ 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....-- ��- ----------..a f1" r.-Q°- """` -------------------------•--------------- -------`--------------------- ` C a • ; Phone Owners Name------ ----=-----r,1------ i�Ll .est Address----------------------- ----- ------------------ -•----------------_--•--------------•--------------•--_.. Contractor's Name------------ --- ---- ------------------------- -------------•------ ._. Phone----------------------------------- Installation will serve: Residence Er-'Apartment House ❑ Commercial ❑ Trailer Court ❑ IMotel ❑ Other ❑ Number of living units: __/_ Number of bedrooms __ Number of baths _ ___ Lot size ---------------------- Water Supply: Public system Rr-6ommunity system ❑ Private ❑ Depth to Water Table !rift. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam..[} Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No�HA/VA: Yes ❑ No ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permiff92if public sewer is available within 200 feet.) ti T T Distance from nearest we14_________________Distance from foundation-------------------Material____.______._.__--__---__________--___________- >'1 ' No. of compartments------ -------------------Size------•-------------------------Liquid depth-----------;--------------Capacity---------------------- spo al Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line-_______________- ` Number of lines__ __ ____Len h of each line------------------------------Width of trench--------._____._________-___________ l Type of filter a terial-----------------_____ epth of filter material_________ _____________Total. length-----------------_________�O.__--- Seepage�Pit:, Distance to Barest;well 'Di nC ro foundation____ __ _______Distan 0e to nearest lot line Number of pi _____�______-_____Linin aterial_ _ -Size: Diameter___-_ _.________Depth ______- (� ----- Cesspool: Distance from ne ____ _ _____Distance_from foundation---------------_----Lining materia _______________________.__________._. El - Size: Diameter----- ---------------------- ----Depth------- --------------------------------------------Liquid Capacity-------------------------- -gals. Privy: Distance from nearest well----------------_--------------------------------Distance from nearest building___________________________-______----_. ❑ Distance to nearest lot line-------------- = ------------------------------ --------------' `-------------------------------•---------------------------------------- Remodeling and/or repairing (describe:_ y ----------- ------------------------------------•---•----------------------------------------------------•------------------------- • •--------------------------- ----------------------------------------------- 1 a -------------------------------------------------.---------------------------------------------------t_.. . ------------------------------ { -------------------------------------------------------____________________________________________________________________________________________________________________________________________________ _ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ws, and rules and gulations of the San Joaquin Local Health District. ordinances, Stat (Signed]._------- - --� - --- ---------- ----------------------------------------- -- (Owner and/or Contractor] By:------------------- (Title) ----- ----------------------- -- -------------- (Plot plan, showing size o lot, location of syste in r ation wells, buildings, etc., can be'placed on reverse side). FOR DEPARTMENT USE.0 LY ------- r � ` DATE =5 APPLICATION ACCEPTED BY__-- _ ---c--'----- �{=4,-------------------------- ==------ .. REVIEWEDBY-------------------------- ---- ---------------------------------------------------------------------------------- -------- DATE----------------------- ----------------------------------- BUILDINGPERMIT ISSUED-----------------------------------------------------------------+----------=-------------------- DATE-----------%- --------------------------------2--------------- Alterationsand/or recommendations------------------------------------------------------------------------------------ ---------------------------------------------------------------------------- ------------------------------------------ r ------ ..... = W ' ----------------------------------------- = ::: - ' _ ; ------------------ -----------------•------- --------------------- 4 tee°y Ar- FINAL INSPECTION - �r--- Date -------- ------------------------------------- n 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-9-2M Revised 0-'59 F.P.Co.