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0-'APPLICATION FOR SANITATION PERMIT Permit No. ...�..��..,r�...__ (Complete in Duplicate) r This Permit Expires 1 Year From Date Issued Date Issued ______//%/Cl/ 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 wit County Ordinance No. 549. 2? 1 . f/C6.14 wI 2!0 JOB ADDRESS AND OCATON ------------ / ------ ---- Owner's Name------- ------fes" .-- Phone ---- -----------•--- Address-----•---------------- - -- -- ------------- - ------------------------------------------•-----•-----•----------------- --- Contractor's Name________________ 1 f`.. * ---------------------' Phon �?--. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _ Number of living units: _----_-- ber of bedrooms ________ Number of baths _W-Mi size __-__^____________________________________________.______ I Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table �J__d ft. N Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe e"H�rdpan ❑ J Previous Application Made: Yes ❑ No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ PE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) x_ eti Tan Distance from nearest well-----------------Distance from foundation-------------------Material____._________________._____________..______.___. No. of compartments--------------------------Size---------------•------------ ---Liquid depth--------------------------Capacity---------- Disposal field: Distance from nearest we11_________________Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material-.- __ _._----_.---Depth of filter materia!----------------------Total length------------------------------------------ ' N Seepage rt: Distance to nearest well bistan e ro fo ndation-__ �_______.Distanc�e to nearest lot line.__ _.___._ � [� Number of pifs.----/------------Lining materia�Gk-_.Size: Diameter__.."/t(')_.....----Depth-----aR�___________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.-----------------------.------._____- ❑ Size. Diameter-------------------------------------Depth--------------------------------- ------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building_________._______________-_____..__--.--. ❑ Distance to nearest lot line----------------------------- --------------------•-I---------------------------------------------------------------------- Remodeling and/or repairing [describe):_ ��------ ---- --- - ----------------------------------- -------------------•-•-------------------------•------------------------------------------------+------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- --------•-------------------------------- I he by certify that I phap-frepared this plication that the work will be done in accordance with San Joaquin County ordinances to laws, andnd regulatio of the S rt Joaquin Local Health District. (Signed)---- --- --- -------- ----- .. /. -- ------------------•----- O ner and/or Contractor) BY� ----------- --- - ........ --- - G ---- -- - - ------Title)----------- ------------- (Plot plan, showing size of lot, locatio of s s em in relation to 'dings, etc., can be placed on reverse side). FOR DEF TME T USE ONLY APPLICATION ACCEPTED BY -- -- --- --- DATE if REVIEWEDBY---------------------------------- ---------- ------------ - ------ DATE ------------------------------- BUILDINGPERMIT ISSUED-------------•--------------------------------•--------------—-------------------------------------- DATE-----:------------------------------------------------------- Alteration� and/or recommendations-------------------------------------------------------------------- -----------------------•-•---------- -------------------•---------------------------------- ----------------------------•------•-- ------�--------------------------------------------------- -------------------------------------------------------------------------- --- --- ---- - CO 3 r ' � -- "r'�,--------------------------------------- ----- -- FINAL INSPECTION BY:--__ .__ 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 Es-9-2M Revised 8-'59 F.P.Co.