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r ov41. - I . APPLICATION FOR SANITATION PERMIT Permit No. ....1� l-�-- _ ` ' (Complete in Duplicate) Date issued -.f �. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance'with County Ordinance No. 549. ' _7 = --------- --- -- JOB ADDRESS AND OCATION------------------ - @" - - ------------------------- = ------ Phone------------------------------------ Owner's Name------------ .O-f1 ....�.._L4_�-L__ ----------------------------------------- -•---------- Address__ "` - ' _.' @ _ -------------- ----------------- Phone AE Contractor's Name------ �" Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ ROther ❑� - Lot size ----- ��_-_---• .-___._ Number of baths ..�:- +� -------- Number of living units: I--_ Number of bedrooms�� Water Supply: Public system R�,01 Community system ❑ Private ❑ Depth to Water Table f. Character of soil to a depth of 3 feet: t Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gg—m rdpan ❑ Previous Application Made: Yes [INo New Construction: Yes ❑ No FHA/VA: Yes ED No [I TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool Permitted if public sewer is available within 200 feet.) Material-----C�--'-�`--`--��-------- . •-~Septic Tank: Distance from nearest well..��=Distance from foundation.._. -- ...._-.- �+ Ca ~cit �4va _ No. of compartments-._-2{. ----Size..; depth --- -- -------- P sy Disposal Field: Distance from nearest well..I0.it�--Distance trom foundation.-.l_Q --_.-..Distance to nearest lot line....-oil._....__ ' _Width of trench...�-5�-.�-�--- --�-------• Number of lines---------�_ Length -of each line..- -Q --------i- Type of filter material._..._. -_w_ ----Depth of filter material-------f�--_._...Total length__-_..... Q` y Y • --� Distance to nearest lot line._. ..._... Seepage Pit: Distance to neares`t well--N --Distance from foundatiarf lei Depth___...-- ` �-- Number of pits----I----------------Lining material--- ------Size: Diameter----.- _. --- Cesspool: Distance from nearest well ................Distance from foundation Lining material...- els. Size: Diameter 1 -----------Depth----•-------------------------------------- --------Liquid Capacity------------•-------_ g ❑ Distance from nearest building------------------------------------------ D Privy: istance from nearest we11...__...__------------ ❑ ------------------------- � 'l Distance to nearest o line.............. . Remodeling and/or repairing [describe)------------------------------------- ------ ----------------------.----------------------------- ----------------------------------------his-------------------------------------------------------------------------------------------------------------------------------------- `i. ave ar ----- --- ------ ication and that I hereby cere+ilayNs� andh ulespand regulations olf the San Joaquin hLocalwork Heawill ltheDisfrlctn accordance with San Joaquin County ordinances, u [Signed]...__-I- � !-- - �- - - ---=�'- - [+ Contractor)- - .-► s . -h,-7v-----[Title]------------------------------------------------- Plot plan, showing size of lot, location of system in relation to Is, buildings, a c., can be placed on reverse side). Y:------------- ------ [ p y I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -'------------------ ---------------- ------------------------------- DATE----------- �� REVIEWED BY------------------------ ---- -- --- --- DATE-------------- 13UILDING.PERMIT ISSU - --------------- Alterations and/or re ommendations•---------------------------------------------- ---- ------- -- -t-;- - - - ----- -- - L tF'i'- - - -- u - - --------- �� ---- -- z 44011------- afie.- 3- - U � JOAQ�UIN��CAL HEALTH D Jnr rte► w-'�[X rt '-P 132 S more Street ( � 814'North 'C'�S� et 130 South eritan Street 300 West Oak Street Y �Cnliforrtir Stockton, California I Lodi, California Menta a, California E5-9-2M Revised 0-'59 F.P.Co.