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v =` APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) d Date Issued This permit Expires 1 Year From 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 LOC TION---------------rl'7-�-�I Owner's Name 7r �/ J-_A�_�'�G--------------- -------------- ---------------------------- ----- ------- Phone_��_:S' ..�1C2�• Address-----------------••-----------�. -/17-------� Contractor's Name----------------------- ------------------ ----------------------------•--------------------------------------------------- Phone----------------------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __- Number of bedrooms __Q_ Number of baths __x--- Lot size .......`7, ......... .. --- =_l__________________ Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes o No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND I SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) (leptic Tank: Distance from nearest well-----_-----------Distance from foundation-------------------.Material--------------------------------------- .__ v l No. of compartments----------- -------------Size--•----r--- ------------------Liquid depth_-------------------------Capacity_-------------------- DisRos I Fiell Distance from nearest well------5.6-._.Distance from foundation:____Je_-1__-Distance to nearestio} line_______ ________ � Number of:lines__ __ __ ___' ----------- Length of each line--------------- 0_"_ Width of trench---------�.a- ----------- - C a T e`of filter material__-_ fTQIFp-___De Depth of filter, material________- - Total length_____._-____---5 __c)_________-____ U yp f p Seepage Pit: Distance:to nearest wei€- C� __Distance fromlyfou dation___.._/Q/�_.Dis#an`to nearest lot line__-__—r- c Size: Diametei__ SL-,e/ q �. Number of pits--------•/-----------Lining material-------"=tr. ' - Depth------ -------------- ` Cesspool: Distance from neares# weff___________--__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--------------- ----------------- -------------------------- v ---------------- f ------- - ----------------- 1 g ; p { • -------- Remodeling and/or repairing describe :_____-_____ -____ _._ _ -------------- ----------------- s' C �=<!/d d_�_�2�L�7C�= 1 --- ,+ ---------------------- GC3 — f 7 = `= C��___ ----- ---------- ------------------------------------------- I,hereby certify that I have prepared this application hat the wo 'will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local-Health District. _ — � ----y � i1SIgned) � --- :.- v- (Owner and/or Contractor) rBy:------------- _ e (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE'ONLY APPLICATION ACCEPTED BY--------- c - DATE-------- 9--v - " s' U REVIEWEDBY--------------------------------------------------------= - -,----------- --------------------------------------- DATE------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE....------ Alterations ---- - - = 3 -- ------------ Alterations and/or recommendations:------- ----•------ ------------------------------------------------------------------- f 1 . r '_� �1 � ' ' ---------- -------------------------------------------------- •-------------------------------------- T -------------------- ---- --- Z - -- Gf / f -------------------------- FINAL INSPECTION BY:---- - - ------ - --------------- ----------- Date-- ------�a' 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 @5.9-2M Revised 8-'59 F.P.Cc,. '-