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-i Permit 'No. APPLICATION FOR; SANITATION PERMIT ._ ._1 (Complete in Duplicate) Date Issued/ ~�1 Application 'is hereby made'-to the San Joaquin Local Health'District for a permit to construct and install the work herein described. This applicatiori is made in compliance with County Ordinance No. S49. JOB ADDRESS AND LOCATION------ - ------ - - C ��JJ / ------------------------------------------•------------------------------- Owner's,Name-------Akze.-f----- % 1- _ Ahone Address----- i _ E? ��_--- ='= - P� v - �--------•------------------------------------ Contractor's Name-------- � -----; ------ lG + �i/`f _ � gl"rje/Phone--------- Installation will serve: Residence KrXApa,rfment House.[3 --Commercial ❑ Trailer Court ❑.,.-Motel ❑ Other ❑ Number of living units: __/_--- Number of bedrooms ____��Number of baths ----/ Lot.size _____ __ __/_____ ....... o_ _.__________ Water Supply:.P blit system Community system ❑ Private ❑ Depth to Water Table ______ ft. Character of soil to a depth of 3-feef: Sand Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe Hardpan ❑ 'Previous Application Made: Yes E] No New Construction: Yes ❑ No ( FHA/VA: Yes ❑ No J� TYPE OF INSTALLATION AND SPECIFICATIONS: (No-septic tank-or`cesspool permitted if-.p b' sewer is available within'200'#'e Se tic Tank: Distance from nearest well_ �TBistance fr m f n a ' n___ __ P� P �rD Mat ia�1 f` - -- No, of compartments_____• ____--Size____ _-___Liquid dept)} .Capacity_____ Dispos Field: Distance from nearest well_ - _&A_kZ4tance from foundatio _________.Distance to nearest lot lin ? Number of lines___________1 ___ -----Length of each line_______ Width of trench-__- Type of filter material___ ____ __ ___________"Depth of filter material____Z�-/-_--Total length------- ._------_-------_---__- Distance to nearest well_______B Distance f n�dation_-.�1 Di ce/��.nearest lot Number of pits Lining materialSize: Diameter_ Cl__,_.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------------------------------------------- ❑ Distanceto nearest lot line --------------`------------------------------------ ---------------- r Remod and or re iri�( escre : - _ -------------------------------------------------------- ---------------------------- --------•------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County a. ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_____X-------------=-------------------------------- " - - -- ------------------------ ---------------------------------------- Contractor) itgY --------------------•-—_� -------• - ----- ------------------------------ (Title)------- - -- u'�<`_ l = _. ; (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_�.---------- ------- - --- --- ---- ------------------------------------------- DATE-.= ---------------------------------------------------- - -- --- -- - -- REVIEWEDBY--------------------------------- --------------------------------------------- --------------------------------- DATE--- - - - --------- - - -------------- - --- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----- ------------------ ----------------------------- Alterations and/or recommendations:----- _= -== -----=----=----- ------------- •--------------------------••-------•-- = -'---------------------------•-------------------------------•------`----------•-----5--.----,-, FINAL INSPECTION BY:--------- -- - ------------------------- ----- Date------wk -IF---------- ------------------------------- 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-9-21x1 Revised 1-57 F.P.co.