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UAPPL)CATION FOR SANITATION PERMIT Permit No. ...1 _C�. - /l (Complete in Duplicate) �4.6�� Date Issued ____ 1 This Permit Expires 1 Year 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. JOB ADDRESS LOC TIO _ -__IJ._�__��-- --------------- - - -- ----------------------- - ---- ----------------•--... ------------------ - .......................... Owner's Name-----Al 7 -- --•-- Phone. _ -- --------------------- --------- --------------------------------------------------- Address------------- - -- V L w ------------------------•-------------------------------------- ---- ---------------- - Contractor's Name--------------- �- V = Phone Installation will serve: Residence ©Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ../---_ Number of bedrooms iz?-_ Number of baths .. Lot size ----,1Q, �: _�__"_""---------------• Water Supply: Public system ❑ Community system ❑ Private [,Depth to Water Table'y,Q_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q---Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes Rj-"No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tpk: Distance from nearest well___,. Zi '"_""_ _. Dista�a from foundation oliunned_r`a/.tion-__-_-1__ -�.._____..-...Material_ --------- ._.-.._".__-___. No. of compartments-----.�___._"_" "_"Size_ _.___� , _..Liquid depth.....�9_{I___---_Capacity_._�Q_ Dis osal ield: Distance from nearest well--- Distance from foundation-__`C1 _ .___ Distance to nearest lot line/_.__ 17 -'Width of trench_..______ Length of eachNumber of lines-----__- _-TYpe of filter material._ De th of filter material--- rtTotal length---------- Seepage t: Distance to nearest well.. .___"-_Distance m�f�'ndation----�_0....-- Distance line-----pits------ Depth------ VJ Cesspool: Distance from nearest well-----•-----------Distance from foundation--------------------Lining material:"""""-."-__._"_-______."_.--________ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well----------------------------_--------------------Distance from nearest building"._-________-"-_-_____"_.____--___._--_._. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------------ Remodelingand/or repairing (describe):-------------------------------------- ----------------------------------------------•----------"----------------"-------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------•--•---------------------------- I herebperti repared this application and that the work will be done in accordance with San Joaquin County ordinances, nd reg tions of the San Joaquin Local Health District. wrier and/or Contractor) (Signed) --------------- ---.------------ ------ By:------------------------------ (Title)-------- - --<------------------------ - -_ -- ------ (Plot plan, showing size of lot, to tio�em in relati to wells, buildings, etc., can be placed on reverse side). FORD ARTMENT USE ONLY APPLICATION ACCEPTED BY------ -- DATE------- P1 ��-- REVIEWEDBY----------------------------------- ------------------------------------------------- DATE-------------------------------------------- --------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations-------------------------------------- ------------------------------------------------------------------------------------------------------------------------- -------------------------- -::--71.. ....................... --- tea..-. . � '4 /A/ S��-_ c �9�0� ----- ----------- --------------- f ,✓' -- -- ----------- ----- =- _ _ .... 3• ------------------------------------------- FINAL INSPECTION BY: - - - - ----- --------------------- Date..---------- 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.Co.