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iv- �-- „ax APPLICATION FOR SANITATION PERMIT Perini No. �'-- ___.. / (� (Complete in Duplicate) F r� 15 y `. Date Issued _-•_-- •------------ Application is hereby made' to the San Joaquin Local Health District for a perm-it to construct and install the work herein described. This application is made im?compliance with County Ordinanc No. 549. JOB ADDRESS AND LOCA ION -1 Wp-------- - �L "'''-------A------------ -------------------------------------------------- Name fLt"t' -------------------------------------- ------------ ------------------------ ------ Phone------------------------------------------- Owner'sAddress---------- - ----- ---•----------------------------------••------------------------------------------------------------------------------------------------ Contractor's Name -- _ e - Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ id ? `�� Number of living units: __l___ Number of bedrooms --r�S.�Number of baths______ Lot size ____�----A_,� ________________________ II � Water Supply: Public system El Community system El Private [Depth to Water Table _l'y ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: Yes ❑ No M"' New Construction: Yes ❑ No R�-' FHA/VA: Yes ❑ No P�' I TYPE OF INSTALLATION, AND SPECIFICATIONS: (No septic tank or`cesspool permitted if public sewer is available within 200 feet.) Vos Distance from nearest well-----------------Distance from foundation_________________.Material-___________________________________._.____-.__. No. of compartments--------------------------Size--------------------------------Liquid clep�h--------------------------Capacity-------------------- �Il /� s - Distance from nearest ` ell_��u-___._Distance from foundation___. ______Distance to nearest lot line___ _____.- Number of lines__________f____ _____________ _Length of each line___r - length----------------------- Seepage ______-----�___�________Q______-- I P 9 See a e Pit: Niu�abce to nearest well____------------------Distance from foundation-------.------------Distance to nearest lot line__.._._______.._ \r ❑ er of p:ts----------------------Lining material-----------------------Size: Diameter-----------------------.Depth--------------------------------- Cesspool: Distance from nearest well----------------- from foundation=_==-------._-__--=-Ling material------------------------------------ Size: ❑ Size: Diameter--------------------------- -- ------Depth_-------------- - -- - Liquid Capacity_____. ---------------_____--gal;. Privy: Distance from nearest well______________-----------------------------------Distance from nearest building ❑ Distance to nearest lot line------. Remodeling and/or repai�ing (describe):------------ -------------------------------------------------------- - Il ----- ----- ------------------------------------------------ --•------=------------------------------------------------------ i .---•-------- -------------------------- ---------------------------------•------ ------------- I` ------------- I`tI ----------------------------------------- --------------------------------------------------------I hereby certify thafil have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, arid rule and regula ions of the San Joaquin Local Health District. Signed . -(Qw "nr Conele tractor) ----i'----------------_-- --- ,. ---------Title (Piot plan, showing size of, lot, location of stem in,relation to wells, buildings, etc., can be placed on reverse side). / _ r} FOR DEPARTMENT USE ONLY 1T APPLICATIONACCEPTED BY--- ---•-------------- __---- -- ------ -- ------------------------------------ ----- DATE----.------- �-------------- t BUILDING NG PERMIT ISSUE -. DATE ;r= ------ --------- D--------------------- ---�--- -- I ---------------------------- DATE--------7- ----------- ---------------------------------- Alterations and/or recommendations:------ ----i- ----------- ------------------ -------------------------------•--------------- ------------ -----------------------•-------------------------------------------------------------------------------- ------------------------------------------- ------•------------------------------------------------ I -- - � - - �------ - - --q----------------�------------ -�--------�----- -------------------•--- - ------------------------•----FI NAL INSPECTION BY;.---- c- ------------ ------- -- ---------- Date---- f ---- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California i` Lodi, California Manteca, California Tracy, California ES-7-2M Revised 1 '57 F_P,CO.