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r APPLICATION- FOR .SANITATION PERMIT Permit No. .5.......... (Complete in Duplicate) This Permit Expires I Year From Date ISSl1e0 Date Issued Application is hereby made to the San Joaquin Local Health�Dist-rict for a permit to construct and install the work herein described. This application is made in compliance with Cour�ty�r tCn- 4!�, J `�. JOB ADDRESS AND LOCATION------------ - �" '. ', `"°i -r-----s' ---- - - _=-- = - Owner`s Namel - ------- Phonel `� J� � AcEdr`ess=- ��_ ------ �+ - ---------------------•-------------------•------------------------•-----•------•-------------------------••--------._. . Contractor's Name:--------------------------••---------------------------------------------- _ --;;,;; Installation will serve Re-ssidence 2- Apartment House ❑ Rommercial E] Trailer Court ElMotel ❑ Other E]Number of living units -- Number of bedrooms _ `_ Number of baths __ __ Lot size _______. _ ___ - .-- - ---------•k ------- Water Supply: Public system [3 Community system Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 Apt:- Sand El Gravel ❑ Sandy Loam ElCIaAloam E] Clay❑, Adobe g-�Hardpan ❑ Previous Application Made: Yes ❑ No 2-- New Construction: Yes Yes ❑ No ©� TYPE OF INSTALLATION AND SPE 1FICATIONS:k # (No septic tank or cesspool perr fled if pubic s w r is available within 2200 feet.) . ... Sept ank: Distance from nea est well______?_-____Distance from foundation------------ i---Material---- ... No. of compartme ts_________.,,,�,�,'_�-------5ize ?1.t_�_�''�-:...Liquid depth---�_�:----------i_Capacity�___[�G�=_�-�_-__�� Dispos I Field: Distance from nearest well- ___1�1°% -.. _Distannge fW f'oo da'o6n__ _ � Distance to nearest lot'line____ir Number of lines---- = -------- Lengltl e-aa�h�ino....-- �-------Width of trench-------- -------------------- Type .--------------- r -_F-_'_-_._- _ _ Type of filter mat Trial____ __ ___ _____ ____Depth of filter Material____ --------Total length_ .___ .- - -- -------------- Seepage _______-_-_ See a e Pit: Distance to neares well _________Distance from foundation____-_-.-_f.....<-Djstance to nearest lot lin ----------------- 42 P g � �•Y:rt...«.�...� I ❑ Number of pits----- ---------- --- g . - - Linin ma�erial-------------------- Size: Diameter------;-------f-------#pth- ----=-;. '------------------ -- - .--Distance from foundation nirimater!al- -------- --- --------------------- - Cesspool: Distance from ne rest well__________ {�,� S;ze: Diameter---- --ne+ ----Depth-------------------------------------------- '- -- iquidtt�pacity_. = gals. �1 Privy: Distance from ne rest well__.__'_---------_1-------_------------------ Distance from nearesT Ejuildin,g ________.___F_____________------.-__--_. ❑ Distance to nears t lot line-- ------------- ----------------------- I------------------• ------------------------- F -------- --------•------ ----------- •---------•------ ... Remodeling and/or repairing (descri e):______-__-___.__',-r-___________________________________ _______ +. -----------------�----------------------------- --•------------------------------------------------------I-------------------------------------------- --------------------------------------I------------------•------ -----------------------)------------- I--------------------- ---------------------------------------------------------------------------------- - - -- ---- ---- - ---- ----------------p---------------Pp --------------------------.--------y--------------------------- -�------------------- ---------------------------------------- i I herebycertifythat I have prepared this application and that the work will be done in accordance with Sanj Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 -- �,� - ----':�- � - ----------------------- Owner and/or Contractor (Signed} ,�-� ✓ ( ) By---------------------------------------- ----------------------�-------------------------------------------} (Title)------------------ --------------__--- --- ------------- (Plot plan, showing size of lot, locatiotoi'sys;em in relation to wells, building ,�etc„ canli ;p"lwa`ce� everse sid ). FOR DEPARTMENT USE ONLY jj I }'� n .�..�... ; APPLICATION ACCEPTED BY-------------.3----- t DATE ---------------------- • � ------ DATE--------)k�--�-•- ---R----------------------- REVIEWED BY----------------------------------------�-..--T__ -- - ----------------------------------- BUILDINGPERMIT ISSUED---------------------I----- -----`-- ------ ------ DATE------------------------------L- ----•---•-------------- Alterations and/or recornmendatians:- --------- ----- `-------- -------------------- —w- - ='..z ""�..-» -------------•-•---- -•-----•-•----------------...--•---•--------------------------------- --------------------------------------------------------------------------------- v---------------------------------------------------------•-- FINAL INSPECTION BY:----AC--w _br4;65--------------------------------- Date--- p------ ----------- ------ ------------ 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.