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APPLICATION FOR SANITATION PERMIT Permit No......1 (Complete in Duplicate) 7J ;Date Issued ____ _ Z_3 __ This Permit Expires 1 Year From Date Issued, Applllliation'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. ] t E_.. JOB ADDRESS "AND LOCATION - ;C" . -- - --- ----� l�f/L+� !>-,----------•------------ ,. ; Owner's Name ---------*-j-- 14,AV ---- :��1"f �s-- ------e ��=------------------ ------------ Phone.--------•-------......----------- Address-------------2l--------- ---------------•------------- -----------------•---------------- Contractor's Name ----------T f _ �-- ----------------------------------------------------------------------•---- ---. Phone ......................... ------- --, Installation will serve:--:Residence.❑,#Apartment House []—Commercial [iTrailer-Court-❑ Motel ❑ Other ❑ NuM'Lb of living units: -- ----- Number of bedroom's Numberof baths -_____-'Lot size__��1rGS_________________________________ Water Supply: Public system El Community system E] Private [i�,Depth to Water Table /A -'ft'. Character of soil to a depth of 3 feet: Sand [Gravel ❑ Sandy..U6am ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Mader Yes ❑ No,�New_.Construction: Yesµ�No;❑ _`FHA%VA: Yes ❑ No ®� TYPE OF -INSTALLATION "AND SPECIFICATIONS: ` (No septic tanVor,cesspodl permitted if public sewer is available within 200 feet.) • - Septic T nk: Distance from nearest well___of�______ Distan e from fLoundatiop___-4-._______._ Material -__c _ __ .�� __-._._____. No: ofcompartments_____,?_____-` .•____Size__,��_X�i---! �L;iquid depth______Capacity_.ZQBQ_______ Disposal Field:i Distance from nearest well__ 7V_0" Distance, Gm :foundatio`_..1AP_�_.-__.Distance to nearest lot line______ _... Number of lines __--- #_Y--------------- Length of -each line/�_Z/'1_a9P_ -Q idth of trench --- ,4e�__``-________________ Type of filter material -. --__ Depth of filter maferial___,lG��_________Total length__6. �__________________________ t Seepage Pit: Distance to nearest well ---------------------- Distance from. foundation --- .,---------------- Distance to nearest lot line ____--_______-_. ❑ Number of pits ------ --------------- Lining material ------------------ Diameter -:----------------`---- Depth --------------------------------- Cesspool: Distance from nearest welL________________Distance from foundation ------------------- material -------------------------------------- Ll _____.__._______._____._.__ _-____.❑ Size: Diameter -------------------------------------- Depth ------------------------------ -_---.---- -.----Liquid Capacity ---------------------------- gals. -61: .. Privy: Distance from nearest well_______________ ____________--____.________._.._Distance from:'hearest'b'uilding.______-_______-----_-________..____------ ❑ Distance to nearest lot line____________ ------------------------------------------------------ Remodeling and/or repairing (describe):__-____ .../._________ - ---------------------- ----------------------- ----- ---------------------------------------------------------------------------------------•-----------------------^I-t�hA �1,?�------- SEK -------------------------------------------------------------------------------------------------------------------------------------- ------ T _ 0 ------------------------------------------ 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. (Signed) Q --v-----------------------------------(Owner and/or Contractor) By: ------------------------ Title ---- - (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY a APPLICATION ACCEPTED BY -,'R_----.--_ _______________ DATE ------ __- �-�--�� REVIEWEDBY------------------------------- - �0-----------•---------------------------------------------------------------------------- _ DATE ------------------------------------------------------------ BUILDING PERMIT ISSUED=---------------------------------------------------------------------------------- DATE------------------------------ ------------------------------ Alterations and/or recommendations -------- -_'__1- -------------------- _--------------------------------- si s ---------- - --------- - ------------------------ - ---- ;f --------- -r(j ---------._---_-.----_-.-.-------------------------------------------------------------- ---------- -------------------- FINAL INSP B -- Date �I'6 0 SAN JOAQUIN LOCAL HEALTH DISTRIC 630 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 5-'59 F.P.Co.