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.,,..- U APPLICATION FOR SANITATION PERMIT Permit No. .....t�.. 1.......... 1 ► " ►/ (Complete in Duplicate) 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. p JOB ADDRESS AND LOCATION ,, � 4 ....... _...,...h --•-- -- ----- Owner's Name.......... ...... - ---- ------ Phorre__ 49 Address ---------_- ---- -- r ...................................... Contractor's Name____ ____________________ ,__ _ . : --•_ Phone .!!!"A". 17 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ .... Number of bedrooms J... Number of baths I.._ Lot size --,Z---.. .. Water Supply: Public system)� Community system ❑ Private ❑ Depth to Water Table __Sle ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe` Hardpan ❑ Previous Application Made: Yes ❑ No l New Construction: Yes ❑ No IV FHA/VA; Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: •� (No septic tank or'cesspool permitted if'public sewer is,available within.200 feet.) Se k: Distance from Weare to ce from foundation ___.___ Material ❑ No. of compart' --_---- ----_Si ...........................____Liquid depth-_- ---•:-------_,_:_Capacity Disposal Field: Distance fro arest well ��//' flId��Di nce from foundation ----------- Distance to nearest lot line-./ Number o es. ____/__ ________ ________L th of each line_______ �__.__-Width of trenchf..�_._,? :`� Type of t r material.--�- th of filter material___.f _______Total length__-__:' a_............ .: ._._ Seepage Pit: Distant t nearest well--- Y111✓F: tante from foundation___._ _....Distance to nearest lot'line.-.,o /.. r, Number its._ __.____ _____Linin m anal-_,�Gt�____Size Diameter ' ��._-_._--Depth ,,,�� Cesspool: Distance arest well Distance from foundation Lining.material_ _,__ ❑ Size:`Diameter----- ----- -------Depth-------------------- ------- ------Liquid Capacity . ..... .... .........gals. ' V� Privy: 'Distance from nearest well.----------------------------------- ________--Distance from nearest building-_-_.- _____:___, .___-__....,___._. ❑ Distance to nearest lot line------ --------------- ---------------------------------..------- ..................... -----• ---- .._...-•- -•- -- -- Remodeling and/or r airing (describe):_-_1:n. ________;�`_?__ -------------------•-------- �`'°r''� ----- - - ------ . -- --- -------------------------------- ------------------------------------------------ ----- --------------------------- ..............................................................------ I hereby certify hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State , an rules a re lations of the San Joaquin Local Health District, (Signed) - ®: �P =''7�, �-� = (Owner and/or Contractor) (Plot plan, showing size of lot,lose ion of system in relation to s, buildings, etc., can be placed on reverse side)._ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ., DATE'S`__ REVIEWED BY--------------------------------- ------- DATE��'j•-- ---- BUILDING PERMIT ISSUED___ DATE -01 Alterations and/gr recommendations --, __- �t 1 e a.+Q. :..• V '�SYt,a..e.rl,utl,,.r,.,� _________ -G...1.J.____ _ __..__ .a-- _.__... ss �``��j R)_7� , _____ _ _________��`�._.-_.-.Sl..__.__.. _, -7.1� fl- .----._ W ter-`°- o v �',�'o.�3e>'7��"�' A PPRWX 6,0 A::). FINAL INSPECTION BY:--_----- � t eD�' oS• / !T QUIN LOCAL H L (STRICT 130 South American Street 3 West Oak Street 132 Sycamore Street 014 North "C"Street Stockton, California Lodi, Ciilifomia Manteca, California Tracy, California` ES-9-2M Revisea 1.57 F.P,CO.