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f, v 7Permit No. _1__. ---•--- APPLICATION FOR SANITATION PERMIT,, (Complete in Duplicate) Date Issued _71/_ASSN �� 2za w o3 Application is hereby made to the San'Joaquin Local Health District for a perms o construct and the rk herein described. Jr This application is made in compliance with County Ordinance No. 549. ------------------- � � JOB ADDRESS AND LOCATION__..____ . � ----- ------- - Phan -E-.. 2— Owner's y©�` %� _ Owner's Name _. •-E ' ' r- ;r xtyf lr1_t�t� =_ Address .lt t / - r --------------- `d! Phone-- Contractor's Name----- .`!_------ i 'r'' �-- f Installation will serve: Residence Apartment House ❑ Commercial ❑------ Trailer Court ❑ Motel ❑ Other ❑ ^' ' t It � _ _ " Number of living units: -".. Number of bedrooms __7Number ('baths size _-_..__. .__f?__ ----f- ' -=�-• la w"? Water Supply: Public system ❑ Community sy, em [I Private Depth to Water Table ft. Character of soil to a depth sof 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay L rri ❑ Clay ❑ Adobe' Hardpan ❑ y; Previous Application Made: .Yes ❑ No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑° PP TY P OF I TALLATION AND SPECIFICATIONS: o septic tank or'cesspool permitted if public sewer is available within 204 feet.] e ..i Tan Distance;from nearest well-----------------Distance from-foundation-------------------EMateriai------------------------------------------------ No. of compartments_______________________ Sixe--------•---------------------- Liquid depth Capacity f l pp f Distance to nearest lot line____�,�____.. Dos d''' Distance from nearest welll_&.._....Distance from foundation ___"____..__. � Number of lines------ �__ _. __ Length of each line__�_4�___-__"------ -Width of trench___ " '� Y� � ? Type of filter material-____° �� Depth of filter material_____��__�__Total length, .��`---------------�-�--- Distanceto nearest well__df'Q�"-----Distance from foundation_- Distanc��to nearest �` line__. __.__-_. Seepage _ Depth__..�' _-Lining material 'E,w' -----------SizeDiameter-____ Number`laf pi#s- 1••--- W !!, # Cesspool: flistance" from nearest well----------------- from foundation__-.---_-__.____-_Lining material___._____.____________________a�s' ❑ Size: Diameter----------------- ------ ----------- Depth-------------------------------------------------- Liquid Capacity----------------------------9 Privy: Distance from nearest well----------------------=------ -- --Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line-- w ---- ------- --------- --------------------------- El '---------------------- I I' ------ RRemodeling and/or repairing (describe):__._"_ `_ ---- --- ----------- emodeling --- ------------ ------------ ----- ------------------------------------ --- I ---------------------------------------------- =-------- - I� 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances to laws, and.,rules and regulations of the Saq,�-Joaquin Le al Health District. (GNamraa- Contractor) (Signe - f .{Title)-- ____ g= -------------- (By' """ buildings, etc, can be placed on reverse side]. i (Plot plan, showing size of lot, location of system in relation to 1s, ii FOR DEPAR MENT USE ONLY j REVIEWED BY---------------- - '--•--------------------- ----------- ----------'- ------------- --- DATE----------------------------� -------------------- APPLICATION ACCEPTED BY-------------------------------------- DATE--------------------t 5 --------------•------- BUILDING PERMIT ISSUED-------------------------------------- DATE___ 1 y :.: Alterations and/or recommendations:-------- --"--" - --- --------------------------" 11. ------------------ ------- - - ----------------------------------------------•--------------------------•-------------------------------- - �° rr .----------------- -------- ----------` ------------- ---------------------------------------•------------------- -------------_-------- I ----- t - -- (-------- ------------ --------- - ------ -------------- ---=-------- - I! - J ------------------------------- I FINAL INSPECTION BY.:----- - -- - �.--- t--- Date ---- f SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California I? Lodi,'California Manteca, California Y ES—' 9-2A4 - Revised 1.57 F.P.Co.