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APPLICATION FOR SANITATION PERMIT Permit No. ._ .Z 7 z-- 9 s��• � � (Complete in Duplicatel �/J/ --••-- -• ~ 1 This Permit Expires 1 Year From Date Issued Date Issued _____ _ __ F. 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 LOCATION... ---- -Ts � 'y = ` Owner's Name ------------------------------------------------------- ----------------------------- Phone-------------------------------- I --- ------- Contractor's Name-_—_Z. ame-- -- ------------------------------------------------- Phone..,&P__-2747'a�--_ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ # Number of living units: __/-__ Number of bedrooms _/__ Number of baths _�___ Lot size ___;��' f= f. , _-tet ------------ ' Water Supply: Public systemCommuriity system E] Private ❑ Depth 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 ❑ ,Noo-ew Construction: Yes ❑ NoI FHA/VA--Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool per.miffed if public sewer is available within 200 feet.) Stic Distance from nearest well-----------------Distance from foundation___________________ Material_______________________________-------____..____- trT No. of compartments--------------------- ----Size_.__. -___ Liquid de th________________---.-...Capacity_ D' sal F' Distance from nearest well--- + --.Distance from foundation____ _ _________Distance to nearest lot line---- Number of lines-- I/ Length of each line_____ _Q _ _ � __`___ __._.Width of trench.__ - .._!_____._._____' Type of filter materia !�1 .t Depth of filter material___-_._.� �/__Total length------- _Q_`______________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_______.__-----:- . ❑ Number of pits---- ----------------Lining material-----_---------.-------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well---_____________Distance from foundation______--------------_Lining material---------.__________.______________- ❑ Size, Diameter --- --------------Depth---------------------------------- --- ----------=--Liquid Capacity----------------------------gals. Privy: Distance from nearest well______________________::__.__________________Distance from nearest building--------------------------------------- ElDistanceto nearest lot line--------------------------------- ------------ ------------------------ ------------------------•------------------------------.------ � r Remodeling and/or repairing (describe)-------------- � •------------- ------------------------------------.-•-------------------------------------- I I f - -.,,,. I hereby certify that I have prepared this application"and +ha+ +he 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) l� - 4 `F Ar¢ t � fl�'• -- ------------ BY: ---------- `{ `Contractor) li :.- -------------- _/I 2ic -- --- rtle ------------------•--••--- --- - --- (Plot plan, showing size of lot, location of system in relation to IIs, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY .r APPLICATION ACCEPTED BY_... r____. ------------------------------------------------------ DATE •------------•---------------------------- REVIEWED BY----------------------------------------- ------- DATE---------------- BUILDING PERMIT ISSUED---------------- --------- --------------------------- DATE Alterations and/or recommendations: '------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------•------ ---- --------- --------------------------- --------------------- -------------------------------- �. -i�LR=- -----•------•--•----- -------------- --------------•--••-•----•---- --------------------------- ------------------------------- --------------------------•-------- -- ---------------------------------------------------------------- ---------------------------------------------------------------------- FINAL INSPECTION BY:.. .� Date------ 0 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oat; Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California j ES-9-2M Revised 8-'59 F,P.Ca.