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APPLICATION FOR SANITATION . PERMIT Permit N o. i� (Complete in Duplicate) This Permit Ex ices ]Year From Date Issued Date Issued __-3% 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 Coun+y rdinance No. 549. BerA'sDNames_-AND LOCATIONd _---�-- ,.-y�y�,;� Ow =_ r-- ------------------------------ Address- ------------- �' �� a ` ----------------_------------ -----------f ---- Contractor's Name..------ � ------,-•--------------------------------•---•-•----•---------------------•---•- I /==�Ca{'--------------- Phone_.__. Installation will serve: Residence c4 Apartment House [] Commercial ❑ Trailer Court ❑ Motel [IOther E]Number of living units: __--- Number of bedrooms __- Number of baths ---- /_ Lot size _____�'00 _e-%� Wafer Supply: Public system E] Community system - ------------ Y Y ❑ Private Depth to Water Table �-y ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Previous Application Made: Yes , Y ❑ Adobe [ —Hardpan ❑ ,i LJ ��o ❑ New Construction: Yes ❑ No ❑ FFIA/VA; Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer' is available within 200 feet.) Septic Tank: Distance" from nearest well_ Distance from ,I _fo-undation__- --___-.Material-.No. of compartments_____� --__----------Size------Y�2 ----"---�'r' •--•--- -Liid dph------------------- Capacity-, --- -� Disposal Field: Distance from nearest well- --- -------- Distance from foundation - 1,P ---Number of lines -------------- I-_--------_- --__ Length of each line -------- -----Distance to nearest lot line_' %��..,; W Type of filter material__1l --------Widtk.of french.. -.9--------------------- ------ ----- _ p Iter ma"terial %,' ------Total length ---------- :`. Seepage Pit: Distance to nearest well �di Distance from - apt of filter --"'�'`7-- om foundation_- FQ Number .,-+-----. istance to nearest lot line t��' of Pits--------- ---------- Lining ,material -----_i% . C .;----Size: Diameter:__ _- -_--- Depth ---- --------_----- Cess Cesspool: I p Distance from nearest well ----------------- Distance from foundation -_--__:--:-,Lining material_________________ _.______- ❑ Size: Diameter ----------------------- -------------- Dept h --------------------------- ------- ---------------------Liquid Capacity ---------------------------- gals. Privy: Distance from nearest well__ Distance from nearest building ------------------------_ ❑ Distance to nearest lot line______----------------- ------------.--. if---- ------------------------------------- -------------------------------- emodeling and/or repairing (describe)________ ---------------------------' ------------ I hereby certify that I have prepared this application and +hat 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. it (Signed) " (Owner and/or Contractor By=�-- ------- -----------------_..-- ----------------------------- --- -----(Title)-- ----- ` ) (Plot plan, showing s'ze f lot, locafion of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ --e , ---- ----------------------------------------- DATE--- REVIEWED BY ------------ ------ -----= -- ------------ -------------- ------------------------------------------------------------------------------- DATE. ------------------------ BUILDWG PERMIT ISSUED -____.__� __ _ DATE----------------------------- ---- -------------------------- A Cera}ions and/or recommendations:_______-.-___._ _- - • - --------------------------- - ----------------------------------------------------------- _________________________-------- _---------------------------------------.______.-__._ 11 -_________----------------------- -`-'�'-� ---,.'.��r'�{-- _i.:c•.)".�_._ ----- ------------------------ -------- ------- - FINAL INSPECTION BY:.__, �: %`.. Date_ g/ ------- ---------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street. i 300 West Oak Proof 132 Sycamore StreBfi Stockton, California � Lodi, California 814 North "C" Street Manfieea, California Tracy, California ES -9-2M Revised 8-'59 F.P.Co.