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APPLICATION FOR SANITATION PERMIT ' Permit No. ....1.. (Complete in Duplicate) Date Issued ---��-�`'- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal+h 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•LO ATION. rz ----- a /{ Owner's Name---------- = �ZZ -- -7 _ `�---- Phone--------------- ------------------ `l +� sG /� ��— -- Phone— Contractor's Name��--_..-�---��- -. Motel ❑ Other Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ . 'LAY ------•-------- i Number of living units: -(---- Number of bedrooms __fir Number of baths _ ---- Lot size ,` , Water Supply: Public system Community system [I Private E] Depth to Water Table's`-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam [I Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No)< New Construction: Yes ❑ NOX FHA/VA: Yes ❑ NOX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) + Septi T Distance from nearest well-----------------Distance from foundation---------_----------Material ---•-Size--------------------------------- --- - Liquid de th Capacity... -- --f Sept No. o��mparfments- ---------�--/---�-- •-- - -----------�-----• q p• Dispos Fed Distance from nearest well....A l"i Distance from foundation___f --------Distance to nearest lot lin ------•• , !�" .J Number of lines-------- ----------Length of each I --______��_-.--Width n trench.__ . -----------------• Type of filter material- .6, of filter material-___./_J-_----�--__Tota! 4ength_,_____ s =-------------• r Seeps�ge Pit: Distance to nearest well__,�[tNjY �----Distance #.tom foundation___- 0-_-___.Distance nearest 40# line -------.- �j( Number of pits-------1------------Lining material--- t-C r�--Size. Diameter.--_.,,-- ------Depth-.-- ----------------- �'C Lining material ----- c Cesspool: Distance from nearest well_________________Distance from foundation----________---- gals. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------- ----- 9 i __._Distance from nearest building Distance from nearest well---------- -------------- ------------------------------------------ Privy:❑ Distance to nearest lot line--------- ----- -------------- -----------------•------=-------------- - - --------------- - Remodeling and/or repairing {describe):__-___.._ .- = • r-----•----` -- - - ^. y/-r� .�.�.�i � ----------------------- --- -- ---- - ----- -----�--- -------------- ----------- -------------------------- -------------- I ---------•--I hereby certify that I have prepar. + application and that the work will be done in accordance with San Joaquin County ordinances, State laws d r s and/ri ions of the San Joaquin Local Health District. (Owner and/or y Con+rector) - -- ---------------- By: (r+lap . -------- ------------ - - ---------------------------- --- - - - - (Plot plan, showing size of lot, location of system in relation to wells, buildin etc., can be laced on reverse side}. FOR DE R MENT USE ONLY APPLICATION ACCEPTED BY------ .__--------- ------- -- -----------------/ ----- DATE--------`� ��`��=-61-�---r-}------------------------- REVIEWED BY . ------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------- DAT . Altera ns and/or- r��ecommendations:-..14___.a-�.[ G----- �« k -•---�``�` -- ---- "let •-------- ------ p /J ", ---- --- ----------- Dole-------------------------- ----------------------------------------------------- FINAL INSPECTION BY-------------------------------- - - -� -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street � •' Trac California Stockton, California Lodi, California Manteca, California y ES-9-2M Revised 8-'59 f.P.Co.