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fbv�AAPOPL/Lft]CATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No. This Permit Exeires I Year From Date Issued Date Issued ---- I -----�-•-•• Application �5 plicationis hereby made to the San Joaquin Local Health District fora permit to construct and ihsta;l the work herein described, application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION ----------- .... jOr Owner's Name ------------------L1_ -76 ---------- 6 ------------------------------ - ------------------------- ------------------ Phone ----- Address ---- • /1. ---- ------------ -------------------- Contractor ------------------- ------ - -------------------- --- --- --- -------- Name ------------------ ----- ----- `� I ------------ 4z�V Phone.. ------------------------------- Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court L] Motel Ej Other E] Number of living units:---/--- Number of bedrooms,�3--- Number of batha___0 Lot size 6 . --------------- Water Supply: Public system A Community system El Private []. Depth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam Ej Clay 0 Adobeo Hardpan E] Previou'-s Application Made: Yes El NoX New Construction: YNFHA/VA: YNo n:esKo 0 es E]9— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool Permitted if publi'c'sewer is available within 200 feet.) Septic Tank: Distance from nearest well-// 'Distance from joundafion-_/e- lvlater�l ------ Li ul d depth."w C, d YV� No. of compartments ------- - ---- ------ Capaci Disposal Field: Distance from nearest well__ k�WW_Disfance fro _�V_e� _-Pisfance to nearest lo line ------ ar Number of lines___.______ _______ __:'__ Length f each lind?�r - ___t/'5___i_9Width of trench_--.,)` --------------- Type of filter rnaferia--.- Depfh� of filter material--- ------- Total length ------- 110059W - - --------- �r Seepage Pit: Distance fo4n'earest fmm f ' datiori--1/0 pund - --- -------- 7.Disfance to nearest jot line ------- *,, --------- Number of pits -----s--------- ----- Lining material_7_�-_Size: Diame Dept k ........ ------ ------ Cesspool; Distance from nearest well__________.___-_ Distance. from foundelt;on ------------------- Lining material-______ Size: Diameter-------------------------------------Depth---------------------------------- ----------------Liquid,. Capacity-. ------------------- -- ------gals. Privy. Distance from nearest well_________________________________---______ -- ____Distance from nearest building' _________.___.______- _- ---------------- ❑ Distance 6iiclinq ------------------------------------------ Distance to nearest ]of line. Remodeling and/or repairing (describe): -------------------- ------------------------------------------------------ ---------------- - --- -------------------------------------------------------- L_ . q --------------------------------------------------- ------------------------------------------------------------------------------ I ----------------- -------------- ------------------------ ------- ------------------------ --------------- ----------------------------------------------------------------------------- __ --------------- t ------------------------------- I hereby certify that I have j3feoared this application and that the work will be done in accordance"with San J o a q' u -'i n_'_'C_'_o_ -u- -n'-f- y__ ordinance's, State laws, and rules and regulations of the San Joaquin Local Health District. I (Signed) -------- X ------ ------------------- --------- --------------- ------- ------------------ r -------------------------------------------------------- .(Owner and/or Contractor) for) Y. --------------------------- _--------------------- i.Sy. ------------------------------------ ---------------------------------•-----------(Title] '------------ -- r ............................... ..... . .. .... (Plot plan, showing size of lot, location of system in relation1fo wells, buildings, etc., can be placed on reverse side). FOR P PARTMENT USE ONLY APPLICATION ACCEPTED BY____.__ ------------------- ------ - -0 ------------------------- ------------------ ------- -------------- DATE REVIEWED BY---- ------------------------------------------------------------------------------ ATE ------- --------------------------- BUILDING PERMIT ISSUED --------------------------------------------------_-------=--------- - �7 . . . ... ....... . DATE ----------------------------- ------------------------------- ------------------------------- I --- — ------- --------- -------- Alferafic) sand/or recommonjdaffions: -------------- -- ----- ------------------ - 7 ---- -------------------------------------- I •a---------- - - - - --ti--- -------------------- - - ---------------•---------- --------------- - - - - - - - - - - - - - ----------- - - - - - - - - -- -Gc�- - - - - - -- - - - - - - - - - - - . . ----------------- ----------------- I ------------------------- ------------------- - ---- --------------------------------- ---------- ----- ------- ------------ ----------------- ---------- -------------------------------- -- - ------------------- ------------------------------ ---- - --- - ------------ I -- - --------------------------------------------------------------------- ------ ------------------------------------------------ ------ --------- ------------- ---------------- ....... .......... ............. .. FINAL INSPECTION BY --- -------- -------- ----------------------------- Date --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak "Street 132 Sycamore Street 814 North "C" Street t. - Stockton, California Lodi, California Manteca, California Tracy, California ES 9-2AA Revised 8-'59 F.P.CD.