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li APPLICATION FOR SANITATION PERMIT Permit No. . / - -72-7 (Complete in Duplicate) This Permit Expires I Year From Date Issued Date Issued .:�k Application is hereby made to the San Joaquin Local Health 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 LOCAT iON -------- -- 0---------------- <• 1_4- ----------------------------------------------------------- Owner's Name--------- Address.-•---- -------------------------------------------------------- -------------= ------------ ------- ------- Contractor's Name-..------- i.1 ------------- ---------------------- !I. --------------------------------------------------------------------------- Phone..--"--"-- Installation hone..........Insfalla+ion will serve: Resiclep'ceNl Apartment House E] Commercial 0 Trailer Court [] Motel 0 Other El Number of living units/----_------- Number of bedrooms-)----- Number of baths _/__ Lot size -_--_-Z C__-:-------(------• 0-a f Supply: Public system,, Community system E] Private 0 Depth to Wafer Table -------- ff. Character of soil to a depfh`gf3 feet: Sand El Gravel El Sandy Loam Ej Clay Loam E] ClayA Adobe Hardpan El Previous Application Made. Yes [-] No.N New Construction: Yes [K No 0 FHA/VA: Yes F] No 1. TYPE OF INSTALLATION:AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer-is available-within 200 feet.) Septic Tank: Distance from nearest.weil_-_AC----Distance fro w founclaf n--Z No. of c6 rm'pa�rtm'e'n'ts Size"z e- Liq ---------------- uid clep�h------ ---------------Capacity_'.rr__ZZ Disposal Field: DiOancefr:P' m nearest well Disl'a'�nce, from foundafion'__X'r---------Distance to nearest lot line_��------------ Type'o�filter material-_.."----- -- Number of likes-----------3---------- Length of each line"_ -""-____"-_____-".Width of trench.._-- . --------6epth of filter material-',,/-,?-,`_f__---.Total Total lengfh_'___/_3------- See age Pit: Distance to nearest well____-/0' 'Distance fr fa ndation----- to nearest lot line- "_57*--- ------------ "C' Number of,:'pits-----;Z;7----- ------Lining material--- ...Size: Diameter_- Z(-------------Dept h... X Cesspool; Distance.fi.-,,om nearest well-__-------------Distance from foundation------- ---------_Lining material-_-.-.-..-------___----------------- r. Size: Dia�nJter--------------:-----------------------Depth----------------------------------- ---------------Liquid.uid Capacity----------------------------gals. I - I ,,, Privy': Distance from nearest well-- "----------------------------------------- --------I--------------------------------Distance from nearest building---------------------------------------- ❑ bisfance Inea Fest lot line-L-1 Remodeling and/or repairing (describe)----------------" -___ -------- -- --- -----------------------------------I----------------------I---------------- ----------------------------_:----------- -------------------------------- --------------------- ------------------------------------------------------------- -- ------------------------------------------------------- - ----- ----------------------------- ----------------------•------------- I -------!i----------------------------------------------------------------------n---------------------------------------------------------------------------- - ---------------------------------------------------I . I - .�___T----------------------:----------------__--------------------------------------------------------i----------------------------------------- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules--6cl regulations of the San Joaquin Local Health District. --- --------------- ---------------- --------------- (Signed)------------------------ ; --- -- 2( ------------------/_ __ l--------- -------Pwirmr-andYor onfracor By:----------------------zz� -----------------------------------------------------ffitle)_-- ---------------------------------- ---- . ............... (Plot plan, showing size of I t, loc n of sy e, relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---._.."3_""" --------------- DATE------- BY -a--- BUILDING PERMIT ISSUED------- ------------ ------ --------------------------------------------------- DATE-- REVIEWED ----, --------------------------- -------------____ -------- -------------------------------I----------------------------------- ---------------- DATE---------Alterionsand/or recdjwmewntir, 47S ---------- --------------------------- --------------------- ------- -- ------------ ----------------------------*---------------*-------------- x-------------- ------------------------- --- ------------ ------------------------- -------------------------------- - -------------------- ---------------- ------------------------------------- 1�4�� --- --- ---------------- ------- -------------------- --------------------------------- -------------------- ------ ;----------- ----------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY _ x----------- -------- Date------ ----------- 6_11-1 4 04� 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 8-'59 F.P.C6.