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A/v APPLICATION FOR SANITATION PERMIT Permit No. ...f 1. _. (Complete in Duplicate) 'T 6 This Permit Expires 1 Year From Date Issued I Date Issued Application is hereby made to the San SJoaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordina ce No. '' I JOB ADDRESS AND TION - Xf�----•-- - --- --- -=�----------•----------------------- I •-------•-------------- Owner's Nam - - -- - -- --•---------- - - 4 ----- Phone �` ------------------------------------------- Address • ----- Y ----•-=----------------------------------------------------•----------------------=I Contractor's Names-� -----•---- ------ Phone_ 7. � ailer Court -❑ Motel ❑ Other ❑ �❑ Apartment ❑ _-_ Number of baths J n, t � Installation Number of lievingRdunits: Numberofbedrooms �Commercial Number o - ! Lot siz __-_ _ ___________________________ Water Supply: Public system R'ommunity system ❑ Private ❑ Depth to Water Ta le -------- ft. , i Character of soil to a depth-of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ay Adobe' '[9- Aardpan ❑ Previous Application Made:.,Yes ❑ No 9 New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No []l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is t Distance from nearest well-----------------Distance from foundation-----s______-_____-Materiai-----------------!.-- No. of compartments---- ize------------------- -------- ---Liquid depth----------- --------------Capilcity----------------------- f / isposal Fie Distance from neare t well . _.Dista_n.ce from.foundation_ -_ _=__.Distance to nearest lot line .._ -..__. Number'of lines___________ ______ _ ____ Length of each line------------- -____�-.Width of trench----_�� Type of filter material_��_ Length of filter material-------"141_____Total length-------0__________________________: ill: Seepage Pit: Distance to nearest well-.---------------------Distance from foundation-------------------.Distance to nearest:,lot line--------------.-. F1Number of pits----i----------------Lining material-----------------------Size: Diameter-----------------------Depth- -- -------------------------- Cesspool: Distance from nearest well_________________Distance from foundatIon--------------------Lining material_- -_ ---_-__-_------ --__._--_. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity-11 Privy: Distance from nearest well_______._______________________'---_______-__--Distance from nearest building----_-___-�� ' ❑ Distance to nearest lot line---A---------------------------------------- ----------------------- -----------------------=-------------------------------------------- -- Remodeling and/or .repairing (describe):----------------'-------------------------------------------------------------•-•---• -----------------------------------I�----------------------------- ------------- ------------ $ -... -- ----------------------------------------------------- --------------- --------------`----- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S ws, and r les and re ulations of the San Joaquin Local Health District. �1 AA1 (Signed)---------- ----- ----- By: --- Lf' = �ncl/or Contract{Owner aor) {Tiitle)------ - ---------------I------ .--- - - - ------ - ---- - ---- (Plot plan, showing size of lot, locati n of system in relatio o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ]� APPLICATION ACCEPTED'BY_______________ �y ------------- REVIEWED BY---------------------------------- --------- - -------------------------------- DATE------ ` ----- l__---�-------------------- BUILDINGPERMIT ISSUED------------•--•-------------------------------------------------------------------- ----------------- DATE---------------- ''M -------------- Alterations and/or recommendations:------ IM. - __... ------- - 3 -- l� -- -- -- --- -- --- -- - ---------- -------------------------------------------------- -- ---- ---------------------------------------------- ----------------------------------------------------------------- -------------- ------ ---------------- ----------- -----------------•-------------------------------------------------------------- ------------ --------------------------------------------- FINAL INSPECTION BY:-------------z -- ----------------------------------------- Date------------ -- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 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 6-'59 F.P.Co.