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APPLICATION FOR SANITATION PERMIT Perm'if No. __...____•___.. _ (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permif to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. . JOB ADDRESS AND.,.rr�LOCATIONx-- Owner's Name �(_U• •3; { ,. __. ff/}11r,} Address---- Contractor's Name_- _ - {� ------------------------ ,r� ; 6 ---------------------� --------- -- -- ---- ___ Installation will serve: . Residence Apartment Nouse ❑ Commerci . E 1=�. railer Court ❑ Motel Number of livor units: � !hem . q ---N of bedrooms- .Number of baths- —Lot size _- umber Wafer Supply:-Public,system community 'system E]- Private ❑;; Depth to Water Table Character of soil.+o a'depth of 3.feet: Sand Gravel !� ❑ ❑?-Sam dy_Loam ❑ Clay Loam ❑ Clay [J ,;Adobe Hardpan 0 Previous Application Mode: Yes ❑ No:�:New Construction:hYes No f 5 ❑ FHA/VA: Yes ❑ s. No TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic +ank.or`cesspool permitted if g it sewer is available within 200 feet) ✓ ` Septic ank: Distance from nearest wel - }istanc f a fou dation__- P ��i----- ---- .Mat ri I __. No. of.compartments------�-- '- ,Size- . I X "._F.-=.Liquid.de th -- --- __ Ca acit .-- f p , Y Disposal Field: Distance from nearest .wellistance from foundation___ �- -_' D,stancelto nearest�ofiIine_ _ ` }7. Y Number of lines_ ______ ___ _ _ _____ - Len th of each line-_____-__ t` /( --------- } - - g �_�, Wid+h of trench__e,2_f---------- ---------- Yp l - i Distance tloeneaaestrlwl II_- stancef filterfmanation_/d_ ! _ Total �engtii---- ------------- ta e to nearest lot G f_ f� S Number of pits__: _ __ ""L'ining-mate�ial__- Size: Diameter_Depth �. @Y p eIL________________Distance from:foundation �material------ -------------- f Cesspool: � Size. ameter_ r --- ------------ Depth -- -------- �-=--•-- - ., -- - _-- --- Liquid Capacity als. + wel1---------------------------- Distance from nearest buildin Privy: Distance from nearest Imgs _ ' ---- Distance to nearest'lot ,lin ----- ----- ---- - --- f i-----�------ Rem ,#ing and/or re airin (de ibe): i `Y 'Q •--------- ---- -••- ---- - ---- -•-- -•-- --- ----------- �. -- _ --------------- --------------------------------________Y___...._ 1 ----------------------- -------------------- _ ________._ I hereby certify the+ I have prepared +hi pplica#sort nd that +hey work will be done in accordance with San Joaquin-C ordinances a laws and rules a la ions of the San Joaquin Local Health District' ounty (Signed)--- � { 1ky ' ----------=------------{Owner and/or Contrador7 --------------------------- (Plot plan, showing size of lot, lots+ion of system in relation to wells, buildings, etc., can(bele) Placed on reverse side). ► = FOR DEPARTMENT USE ONLY—,,,,. A APPLICATION ACCEPTED BY---------------- ----- - -- ---_-_- DATE BY --"----------- --------•--- - - - ------ " B[JILDING PERMIT ISSUED - -- 1c,0A --- '�i E- DAT E _ -S` Alterations and/or recommenda+ions;_______ BRG ------------------------- ------=--•------- 0148 h{ � L- -= ...-- ------------------------------------------------------ ------ --------------------------- --•------------- opa ''_Cp--------------- _ i �. _ _ ___________ _ r ------- = _1.75_ :__ - �C � --------- -.31�_�---"1.� -- - ------ ----- - ------ -------- --=-- -- ,�- f FINAL INSPECT BY:. -- - Date------ ------ — --------------------------------7k q QUIN LOCAL HEALTH DISTRICT f,? 130 South Amarecan Strut n y1 14 ' 1 — 30 �1�5%est',08 Street 132 Sycamore Street 814 North "C" Street Stockton, California odi, 'Cali% rnia Manteca, California Tracy, California E5— 4-2M Revised 1-57 F.P.CO.