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...... APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued S'lpplication is hereby made to the Saoa n Joaquin Local Health District for a permit to construct, and install the work herein described Aq This application is made in compliance with County Ordinance No. 549. �F ----- ------------------ ,/ 11 JOB ADDRESS AN D• L CATION__�__�_`��-_-�`�-`----- -- --- �- f - , Pho Owners Name- - ---- -- --------- � Address---- f "'1'-- l - o I Contractor's Name_..___ -0--•-------- ------ ----- - Installation will serve: Residence Apartment House Commercial ❑ Trailer Court Motel Other ❑ ---------------------- ---- Lot size __-- _ _ - -- Number of living units: _ ----- Number of bedrooms,, Number of baths __� >� i. Water Supply: Public system` Community system El Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay E] Adobe Hardpan ❑ � Previous Application Made:i Yes C:1 Nog New Construction: Yes No ❑ FHA/VA: Yes El " N e TYPE OF INSTALLATION SAND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4ag I _ Distance from nearesfi well______._-____--Distance from foundation__.-____________--.Materia_______________-_--_____------------------- --- No:of compartments. ------------Size------•---------------------=- Liquid depth_ Capacity I s Distance from nearest well-_____-_______._Dis#ante from foundation______.._______-.__Distance to nearest lot line..____--._-_-___,-"Number,of lines-----------------------------------Length of each line-----------------------------Width of trench----------------------------------- Type of fiiter material-------------- -------Depth of filter material----.__----------------Total length_------------.----------- � `___Distance from f dafiiori_ .._..___..Dis#ance to nearest lot line ___-____""Distance to nearest wefi,�t � 9 nn ! ' r * Numbers of pits._.__ ----Lining material- _ ---Size: Diameter__-- J----- ----.Depth-- cam'--- i Cesspool:' I Distance from.nearest well_________________Distance from foundation._-_____---_.-•___-.Lining material____.._____----___.____.----_-------"--N •rte ❑ Size: Diameter ----------Depth----------------------------- ---------------------Liquid Capacity--- ------------------------gay L. -41 Privy: Distance frominearest welL------------------------------------------------Distance from nearest building_________.___________-_________..- -_._. ❑ Distance to nearest lot line - -- c --mss-�`�'� - - -•' - -- --- - ----v - -- Remodeling and r repainn'q (describe):__- --- - I --- - -------------------- - - ----------------------------------------------•-------------------------------------••---•------------------------------------------------------•----------------------------------------------------------- I hereby certify that i have prepar d this app cation nd that a work will be done in accordance with San Joaquin County ordinances, - to laws, r,d rules n egulatia�s Wthe aX Joa min Local Health District. ontract ned ----- ------ (Sic ------`- --------------------(Owner a d/or C or) ) " ----`---:-------- ----- Title ---- •-------------------- -- I By---------- --- ,,� (Plot plan, sh size f lot, lacatio s s m re ion to wells, buildings, etc., can b p aced on reversed e). FOR DEPARTMENT USE ONLY j' DATE-------- - KAPPLICATION ACCEPTED BY___- rJR-k-0-------------------------------- REVIEWED BY------------------------------------- -------- --------- ---------- --------- --------- ---------- ----------- ---- DATE----------------------------------------------------------- BUILDING"PERMIT ISSUED__--------------------------------------- ---------------------------------------------- DATE----------------------------------------------------------- Alterations"and/or, recommendations- ) -Q- ------------------- ----------------- L S--C �"' '_`J -�'-p-------------------------•. --------------- )?I r x---'�-?--------- � + - a ------------------------ -------------------------- - _ - - ----.--- -- - -- - �- .F --------------------- IDate--------- -----------------------------------" FINAL INSPECT-I. N BY: � y � ------------- - f SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wes+Oak Street 132 Sycamore Street 814 North "C" Street !30 South American Street 'frac California Stockton, California Lodi, California Manteca, California Y. E5—9.-2M Revises 1.57 F.P.CO.