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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) (� This Permit Expires 1 Year From Date Issued Date issued ______��.! �4 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_.__ Q _--± --11�r F �1 f ------- .- Phone Owners Name----- -------------•-------- -�-'x>hr_------�� --� Address Contractor's Name, x�'c]cznr IF ---- -- ---at/ g��----- 'I .! �t s oi .,� .�+�------- Ph ne------•---•----------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: __ __ Number of bedrooms Number baths - ______ Lot size Water Supply: Public system ❑ Community system ❑ Private �Deepth to Water Table/4'l",ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ i Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sew6r is available within 200 feet Septic Tank: Distance from nearest wel�0a_ ncfrom-found �pw_1�.' "�ate rial _Adw-"l `- --d-----.® No, of compartments__--__ ______ ze___ _3__ Li uid de th-_______1_ Capacity f - Disposal Field: , Distance from nearest well___SP ance from foundation-_Id+y"ististance to nearest lot line-- Number -- Width of trench --� tr Number of lines.____ Length of each line_______ --__ Type of filter material--- -4 Depth of filter material-___-?_e-_--__-Total length---------- Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El 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___---__-_______- ,Q ❑ Distance to nearest lot line---------------------------------- Remodeling ------------ -----------------=Remodeling and/or repairing (describe): l �- ={"`- ti�f --•--------------•------------•------ I ------------------------------------ --------------------------------------------------------------------------•-----••---------------------•-#-------• -------- --------------------•------------------------------ S I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I ,ws, and rules and regula ions of the San Joaquin Local Health District. I (Signed)_k: ----------- - -----_____-_----._,:__(Owner and/or Contractor) By:- •---------••----------------•--------••------------------------------------------ -------------------------------------------(Title)----------------------------- ---------- -- - - ------------ - (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc., can be placed on reverse side). I R A MENPUSE O APPLICATION ACCEPTED BY____ ___ -- --� / - -- - iE- - - -W� REVIEWED ------------------------- BY i----------------- ---------- DATE BUILDING PERMIT ISSUED --------------------`---—-------------------------------------- DATE Alterations and/or recommendations:-------.-------------- -------------------- 451 cN ----- �$ ---------- -------------------------------- -P ------------ T ------ n ` -_ �� ---- ------- ------ex- -------- ----------------------------------------------•---------------- --------------------------------- l2La fNSPECTION date------ ------------- - ----- - - -- 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 0-'59 F.P.Co,