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1U1r � _ . APPLICATION FOR SANITATION TION PERMIT (Complete in Duplicate) Permit No. Application is hereby made to the SanrJoaquin Local Health District fog Date Issued This application is made in compl;,Sannce Jowith Count r a permit to construct and ins+all the work herein described. JOB ADDRESS AND LOCAT Y Ordinance No. 549. N Owner's Name-------------- -- --- . - dress_ _ C a Phone_ -.-- �-Z- Contractor's ! w a ._ Name------------- -- -- --- ----- yy Installa+ion will serve: Residence ----- ---=----- - Apartment House : Phone__. Number of living units: ommercial Number of bedrooms ❑ TZot Court ❑ Motel Water Supply: Publics stem Number of baths � OtherYCommunity system, size __.-�� Character of soil to a depth of 3 fee+: Sand ❑ private ❑ Depth to'Water Table ._____-_ { Previous Application Made: Yes ❑ Gravel ft pp ❑ Sandy Loam ❑ yClay Loam ❑ No_ ew Construction: Yes I] No ❑ Clay ❑ AdobaA, Hardpan [] TYPE OF INSTALLATION AND SPECIFICATIONS: - �E PHA%VA, Yes 0 No (No septic tank or'cesspool permitted if!public sewer is is Tavailable within-2p0 feet.) r, Distance from nearest well__- : { -----_Distance from foundation_-._: No_ of compartments------------- - Size__--- H. Material ------•-- 4-411- s� Distance from nearest well. -- ----------_--Liquid depth.......................... Capacity_.------ _I Number of lines-------/"_____-�0f(__Distance from foundation__ !��`' �---- -----_Distance to nearest loft line--Z, " Length of each line--------- Type of filter materia[_ _-.-__- Depth of filfier material__---_ �P Seepage Pit: p ,� _-.-.Width of trench-- --- Distance to nearest well_-4_yt*e---_-_Distance from foundation__ � --- --- -------- . ---`'----Total length-- ----.s�'!_ Number of its--- ---------.Distance to nearest lot fine- Cesspool: Lining material_ c�__ __ ---------Cesspool; Distance from nearest well___- Distance from foundation Diameter r r C--------------------- Privy: --- Size: Diameter-------___f___ _ ____ _ _ _ Lining material__ _----------------------------- ------- --__--_-_ Priv -------- epth---------------------------- =------------------- y' Distance from nearest well___-�----------- -- - -------- --- ---- Liquid Capacity-----_-_--___-............ __Distance from nearest building gals, ' Distance to nearest Ibf line-------------------------------- --- ;,;a--------------------------- -; G Rerriodelin and w,a:;,,::.�- ------------------ -I g -- ----------- --------------- ----------------------- or repairing (describe).__--___ ------------- ----- ----•---------• ----•-------------------------------- ---------•------------------------------- ---------------•-------•--------------------------------------------- ____ _ 1 hereby cert' that I have prepared this application and that the work will be done in accordance w' ordinancesXaws, nd rules and regu ations of the San Joaqui Local Health District. 4 ith San Joaquin County(Signed)----• �` - ---- ---------- - - ---------- --------------------------- LrtJ s--------------- ��- Or Con`+ractor] (Plot plan, showing size of to}, location of system in a#ion to wells, bu' ings, etc, can I -----------------------{Title)------- -___r v_e_r -__side)------------ . be placed on reverse side), - ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ l� �.-)----•-------------REVIEWED BY----------- -- ---------------------•--=------------------ ', BUILDING PERMIT ISSUED--------------------•_--_-- DATE----- - j------.----------------------- -- - ----------------------- Alterations and/or recommendations_____ ----------- -- --------- DATE___---_---_-.--__--- ---'---- ---- -----------------•_-- ---- ---------------------------------------- ----------------------------- ------------- --- • ----- I ---------- INAL INSP 1 L.,BY - _ Date--- / - _'. . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street 814 North "C" Street Lodi, California Mentees, California Trac � y, California l —2M Revised 1.57 F-P,Co.