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APPLICATION FOR SANITATION PERMIT Permit No. ..� 1,7 � (Complete in Duplicate) /Q Date Issued This Permit Expires 1 Year From Date Issued Application is hereby madejlto the San Joaquin Local Heal+hE'District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOg ADDRESS AND LOCATION ----- Owner's Name f, x/tl� .rl��--------------•--- ,f ------------------- Phone__. Address------------------- - - -------- -------;--- ---------- -- ----------------- ----------------------- Contractor s Name---------------- Installation -------------NInstallation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I. �s 1 Number of living units: _ - Number of bedrooms _,Number of baths - ____ Lot size __-_- Water Supply: Public syste Community system ❑ Private ❑ Depth to Water Table -1/oft. Character of soil to a depth1of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe Hardpan Previous Application Made: :'Yes ❑ No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND 5PECi (CATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ' ank: Distance Nrom nearest well_________________Distance from foundation_-.___-_.____-_..__.Material__-__-.-1.-._ __.-_..___-.._ -- ------ No. of compartments- ----------------- -----Size-------------------- Liquid depth-- - Capacity Disph eld: Distance��rom nearest well.................Distance from foundation.______..--.____--_Distance to nearest lot line_--_--_-___-_____ ' f ! Number of lines-----------------------------------Length of each line------------------------------Width of trench ------------------___--- - �� Type of filter material___--_._________________Depth of filter material_.__---___-_--`---_.-Total length_--____-___-___-_-_______________-_ - h Seepa a Pit: Distance:�o nearest well---,�/�/��'.__Distance fr fou dation-_ � +L� - - ��-._...__..Distance to nearest lot line-._+�----____ Number 3f pits-------/-----------Lining material-__ �Z_Size: Diameter-__-- - „•� I� Cesspool: Distance from nearest well____-_-_____._ Distance from foundation-----_--------------Lining material--- --__-.___--.-----._____-_._-_____. ❑ Size: Diameter---------- --------------------------De Depth - - --------------- Liquid Capacity----------------------------gals. Privy: Distance From nearest well-------------------------------------------------Distance from nearest building E. ❑ Distance to nearest lot line = - Remodeling and/or repairing [describe):__ -- -- ---------------------------------- `----------------------------- ---------------- --------------------------- ---- --------- ------- =------- ------------ r' —.. ------------------------------------------------------------------- 1 I hereby certify that I halve prepared this applic nd that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule - nd regulations the Sa Joaquin Local Health District. {Si ned 9 )------------------- ---- ----- :------• --- -- -- ----- -----��- - - / --'------ -- Owner- -- --- Owner and/or Contractor) BY:------------------------------- �- = � - ----------- -�G'--- -------(Tifie} (Piot plan, showing size of lot, locati of system in relafion to wells, buildings, , can be placed on reverse side). di FOR DEPARTMENT_USE ONLY i J1, APPLICATION ACCEPTED BiYi `--------------------------------------------------------------- DATE---- - - - ----------- REVIEWED BY -- ----- -- -- =10 DATE -------------------------:---------------------------- - - -------------------- BUILDING PERMIT 15511ED `:---------- ------------------------------ ------------------------------ DATE Alterations and/or recommendations-------------------- � -- i ----------- ------------------------------------------------•-----------------------------------•-------------•------------------- ------------------------- ---•-------------+r M-------------------- --I------- ----- ---- - - ------------------------------------- I� -------------------------------------------------- -- -------- - ---- -------- ------- - ---------------------------------------- --- ----------------------- -- ------------------------------------- ----- -- -----•- - FINAL INSPECTI ---------- ---------- -------- ----------------- Date----- ��'r/-".�. . 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 ES-9-2M Revised 8-'59 F.P.CD.