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-71 APPLICATION FOR SANITATION PERMIT Permit No. 22.2:01_4-. -- (Complete in Duplicate) '}v 3 0 G This Permit Expires 1 Year From Date Issued Date Issued -__ Application iserF y 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.f- JOB ADDRESS AND LOCATION------ _/ ! _ Q'._.._ �� t _..-----•-----------------------------------•--------•------------ 4 � Owner's Name- r ----- Phone Address ------ ---- Contractor's Name_____ y_ Phone................................... ---------- --------------------------------------------------- ----------------------•------------ Installation will serve: Residence .(Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms S--- Number of baths/ Y Lot size __ ��f! - --- - ----------------------------- Water Supply: Public sys em mmunity system ❑ Private ❑ Depth to Water Table fc.," Character of soil to a depth eet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No P--*`N*ew Construction: Yes Cg"qo ❑ FHANA: Yes ❑ No 9'" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest well_______—____Distance rom foundation-_.149___-___.Mates j__ V�'� G No. of compartments----- ---------------- uid de th_..!01 Ca acit _ Size. Disposal Id: Distance from nearest well--- Distance from foundation---/�.�__.__Distance to nearest lot line..as�_.__.--- _. EFi Number of lines______ �__ ____rr_Length of each line___��!______._:_---Width of trench_ _��____-_-_______-__- Type of filter material_1VA epth of filter material___-� f�_.__Total length______.�cs'�._f. ... _______________ Seepage it: Distance to nearest well- ---- fr m fou dation....le-___._--Distance to nearest lot line7�......... Number of pits__-. __________Lining matenai.'. 0, .Size: Diameter__ . _!_-----Depth___ L_____-_________. 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------------------------------------------ 1771 Distance to nearest lot line-----------------------------------------------------------------------------------•----------------------------------• --------------------- Remodeling and/or repairing (describe):----------� �'=-�- ----- •--•----------------------- --------------------•---------------------------------•-------•-------•----------------•-------------------------.-------------------------------------------------------------------•---------------•------------------- ----------------------------•---------------------------------------------------------------------------------------•--------------------------------- --------------------------------------------------------------------- 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 reguI tip s of the San Joaquin Local Health District. (Signed) A � ---------W"* -----------------------------------------•--------- wxRW3E Contractor) ---------------------------------------------------- By:---------------------------------------------------------- ---- --------------------------------(Title)--- 1$4s-�- ----- ------- ---- --------- (Plot plan, showing size of lot, location of m in relation to wells,.buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------- DATE---•---- y ----------- --------------- _ tet (k-� REVIEWED BY------------- - ----------------------------------- DATE .............................................. BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ Alterationsand/or recommendations--------------- ----------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------- ---....... .---=----------------------- ----------------------- ---- ------- --------------------------- `�" �"7 ! '----•----------�------ - -----c-4---�----�- --------fir --- - - ----------- - - zea-c'� --------------------------------------------------------------------------------------------------------------------------------------------------------------------------``-------------------------------------------------- FINALINSPECTION 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 E8-9-2M Revised 8-'59 F.P.Co. A