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APPLICATION `FOR SANITATION, PERMIT Perr*sW4c,,Z_5__........... This Permit Expires 1 YeeDuplicate) 'P Date Issued From Date Issued 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. 0 JOB ADDRESS AND L CATION. , < A.,e --------------------------------------------------------------------------•------------ Owner's Name.-------- --/X- t------ .r J .1_.. ' Phone ••------------------ --------------------------- Address------------- - -- Contractor's Name -------- --------------------------------------------------------------_ Phone----------------------------------- - Installation will serve: Residence Apartment House ❑ Commer'cialL�❑ Trailer Court E] Motel ❑ Other ❑ Number of livingunits: _ ___ Number of bedrooms'__,;2--_ Number of bath;__ __ Lot size �-_,� _ _.r------------------------------_-._-_._ Water Supply: Public system [Community system 0 Private/El Depth-4o Water Table __�-, It. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sai1�y Loam-7[_1\ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No g3l"'New Construction:,Y,es's',❑ No.'®— FHA/VA: Yes ❑ No E?.— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s S pti4 Tank: Distance from nearest well------------------ from foundation--------------------Material _-._----------.-_.---.--_---_--_--. _1------- 1 /,4 s No. of compartments-------------------------?Sizer -!-------------------------Liquid depth---------- ------ --------Capacity----------------------- Disposal Field: Distance from nearest well................;Distance from foundation--------------------Distance to nearest lot line----------------- AXNumber of lines-----------------------------------Length of each line------------------------------Width of trench-------------------------------- Type of filter material_________________________lDepth of filter mate-ial_---------------------_Total length_---------------_:_-------__---_---------- Seepage Pit: Distance to nearest well _.-:=�._---_--Distance rn-- nd ' ion___-4P.P...._._.Distance to nearest�t line---/ ------ .;yOd ®�! Number of pits--------Z----------Lining mater' s .Size: Diameter---% _.__._Depth___._.07'0_---______._--_ f_ Cesspool: Distance from nearest well-----------------D• tancesfro' .oundatio'n____---___---_-._.Lining material_______-_--__.-_._.________---__-_-. Size: Diameter-------------------------------------De ` ------------------------------------Liquid Capacity gals. Privy: Distance from nearest well---------------------------------__.__.________-Distance from nearest building---------------------------------- -.--. _ ❑ Distance to nearest lot line--------------------------------! -------------------------------------------------------------------------------------------- �� I-' -- - — Remodeling and/or repairing (describe)=- ---- ------------f.-¢= -'r�- �•- ---� ----------F---•---------------------------------------•---------------- } ---------------------- -------------------------------------------------------------------•-------------•----- -------------------------------------------'------------------------------------------ , 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 and regulations of the San Joaquin Local Health District. ` (Si ned `_ ® ` 5 )----•- ----------- -• ---- ---�--- -- �•-��-� -- --------------------------------------------�--------------[Q6w%ecznad/or Contractor) By:---------------- --•--------------- �sysfem � --------€--------------------------------------(Ti+le) �/Z�' .......... ----------------- (Plot plan, showing size of lot, loc n relafion to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT`USE`ONLY' ` --� r APPLICATION ACCEPTED BY------ e{ a 5 --`---------------------------------------------------------------- DATE---- 1-12---- ---------------- REVIEWED BY--------------------------------------------- -------------------------------------------------------------------------------- DATE-------------------------- ------------ ---------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------------------------- ----------- Alterationsand/or recommendations:-------------------------------------------------------------------------•----------------------------------------------------•-------------------------- -------------------------------•--------------------•--------------------------------------------------------------•----------------------------------•--------------------------------- ----------------•------------------- ---------------------------------------------------•- ----- - - -------------- D- - ---------------------------•-----• ----•- - ----•-------------- - -------------- ------------------ - --- --- ---- --- ---- ---- ----- ------- ------- ---- - ----- -- ------------ ---f -- ------ --------------- ------------------------------------------------------------------ f 102 FINAL INSPECTION Y:- Date f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street,' ,132 Sycamore Sties+ 814 North "C" Streat Stockton, California Lodi, California Manteca, California Tracy, California F ES-9-2M Revised 8-'59 F.P.Co. r