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APPLICATION FOR SANITATION PERMIT Permit No. ._�- __T_7`_U (Complete in Duplicate) r 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. (� JOB ADDRESS AND LOCATION---------1-_909------- I O�` J'�7�LJ� CMJ --------- ----- Owner's -- - Owner's Name--------------- i - Phone ~ Y ---- - LI; Address -- --C �� -----��-_ � � �f �- -- --- - ` - ------- - ------------------ Contractor's Name /1t'--------------------------------------------------------- ---------------------------- -------------- Phone--------------------•-------------= Installation will serve: Residence ©Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 Number of Living units:�---I___ Number of bedrooms ---/-- Number of baths ---1- Lot size ----�5-0---X_)S Water Supply: Public system 0--60mmunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M-,Hardpan ❑ Previous Application Made: Yes ❑ No [9/New Construction: Yes E4Ao ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) .. f Septic Tank: Distance from. nearest wel11-,N Distance from foundation--- 0-__---------Material----- --------- ---------------+1. ❑� No. of compartments`---- ----------------Size--R-Y---A/.K-4:7�----Liquid depth------'V--------------.-Capacity----- 1 --------- ----- � i t Disposal Field: Distance from nearest wo- ll3�II�_._.Distance from foundation---10------------Distance to nearest lot line_=�.-______. [� --------- of trench__2� e-____-.---_-_ -_-. , Type of filter material-__-Y-04-----_Depth of filter material_______1g_-__-------Total length--------------TO______________________ Seepage Pit: Distance to nearest well-----------------------Distance from foundation-__..---------------Distance to nearest lot line___-_____.______ ❑ Number of pits_---------r-_---------Lining material-----------------------Size: Diameter-------------- _ -------.Depth ----------------------- ---- Q , Cesspool: Distance from nearest well-------------- Distance from foundation-------------- material_ _______-_- ❑ Size: Diameter------------------------- -----------Depth----------------------------------- ----------------Liquid Capacity----------------------------gals, `l\ Privy: Distance from nearest well__'__---------------------------------------_-_-_Distance from nearest building___________________-___--------_------- ❑ Distance to nearest lot fine--------------------------- Remodeling -----------------Remodeling and/or repairing (describe)--- ---------------------------------- --------------------------------------------------------- ___________________________________________________________________.,_______-__-________________.--------------------------- ----------------------------------------------------------------------------------------------- ----- -----------------------------_-------------------------------_---------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application 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: R (Signed)--------------------------------------------------------------------------------------------------------------------------------------------- -------------------(Owner and/or Contractor).' BYr --------------------------------------------------------------------(Title)------------------------------------------- --- ---------------- (Plot plan, showing size of lot, location in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ----- `-------------------------------------DATE-------1 REVIEWEDBY-------------------------------------------- --------------------------------- ------------------------•-------------------- DATE BUILDING PERMIT ISSUED------------ -------------------------------------------------•--------------------------------------- DATE Alterations and/or recommendations-------- ---------------------------- -------- ----------------------------- ----------------•----------------------------------- -•--------------------------------------------------•--•-----------------------------------------------------------------------------------------------------•-••----------------------•------•-------•--------••-------•-- A ----------•-----------------------------------•--------•------- ------------------------------------------------------------------- -------------------------------------------------------- -------------------------------_ FINAL INSPECTION BY: ,/'^ ------------ Date-----1 ---------------------------- SAN JOAQUIN LOC L HEALTH DISTRICT F 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 1-57 F.P,CO.