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APPLICATION FOR SANITATION PERMIT Permit No. Z f_�/O-__ ` (Complete in Duplicate) pate issued This Permit Expires 1 Year From Date Issued 0S I —IUD---10 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 LO.CATION--- --A ----- -- Y --•----- - ---- -- ------------------------------ ------- Owner's Name-----;;;t�ll-------- #.� -- --------------------------------------- Phone-----------.._------------- Address ---- ----- V -- Contractor's Name_,.,Z-& ra-[ --•------•--------------•------•------------------------------- ------------._. Phone------------------------- installation will serve: R„a5iclenee4 Apartment House'] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I____ Number of bedrooms _,3__ Number of baths ---I--- Lot size ______V_0_0__.x____L:r__0------------------------ Water Supply: Public system % Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand fl Gravel ❑ Sandy Loarn M Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous, Application Made: Yes ❑ No (9 New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ 'elf O TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic rank: Distance from nearest well_________________Distance from foundation--------------------Material __________________________-_______________- ❑ No. of compartments--------------- Size---------------------------------Liquid depth-------- Capacity----------------------- ' Disposal Field: Distance from nearest well-JOV- LL—Distance from foundation__�A i-......Distance to nearest lot line____-____-__- Number of lines________ ___ _ __ Length of each line______ Width of trench---3l.-"___-------------__--- Type of filter material__ (1 _Depth of filter material-__M -_-_____._Total length____-q_7_______________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation___________________.Distance to nearest lot line______._______.__ ❑ Number of pits----------------------Lining material-----------------------Size. Diameter-----------------------Dept h_._..---------------------------- Cesspool: Distance fi•om nearest well-----------------Distance from foundation--------------------Lining material-_______.._________________________. ❑ 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):---- - ----- ------or t-- �/_ '""rer 1---------------------------- ------ - - -------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ -------------------------------------------------•-------------•-- ----------------•--------•-------------------•----------------------------- ------- - - --- -------- ----- - 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and rules and regulations of the San Joaquin Local Health District. (Signed)--- --- sca --- --- -----------------------------------------------------------------------(Owner and/or Contractor) Bi B -------------- --------------------------------------(Title)------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------------ DATE/�_`--�"_760 - --------------------- Lf ------ ---------------------------- ------------ ---- --�-------------- ------- REVIEWEDBY---------------------------------------------------------- ------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-•------- ------------------------------------ --- ± � � ------------ ------------- ,y � ------------� -- ---------------------------------------------------------------------------------------- FINAL INSPECTION BY:.--- ----- ------------------------------------ Date--- - - --------------------- ------- .......... ------------ ----------- SAN ----- - 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 FS-9-2ld Revised 8-'59 F.P.CD.