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'APPLICATION FOR SANITATION PERMIT Permit No. ._1. (Complete in Duplicate) Date Issued I This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local 'Health District for a permit to construct and install the work herein described. PP E No. 549. . P This application is made m compliance with County-,Ordinance JOB ADDRESS AND LOCATIO = - 1� ------ Owner's Name - �WV ✓ -- -----1!11! ------- Phone----•---------------------------•--- - --•-4--'-------------------=------ •---------- Address ---------------------------•--------•---------_------ ` ----I----------------------- •------------ Phone. Contractor's Name------ -----------------------------------' = Installation will serve: Residence Apartment House❑ Commercial EliTIrailer Court ❑ Mote10 l ❑ Other E] Number of living units: __ -- Number of bedrooms � ` Number of baths /--- Lot size ,1V5 -,rte -----f-----•--------------- /T ft. Water Supply:' Public system Community system ❑ Private ❑ D pth iTo Water Table 1 Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam'❑ Clay Loam ❑ Clay ❑ Adoberdpan F1 Previous Application Made: Yes E] .[No New Construction: Yes El -No 2T--FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public'sewer is available within 200 feet.) Se c Tank: Distance from-nearest well__--_____________Distance from found�aton-------------------.Material_________-_____- ___.-----------.-.------- _ - -l 11u'I _ 0�--r---- . -------- - -.---------Capacity S ----------- -- e---11Lcth----No. of compartments--------------- ---- ---- ize-------- ils bis o$al Fi Id: Distance from nearest well______ ____Dan ofrohanon-__ � . >�� ----- ---- --- umber of linesLength In -- � Width of trench-__ f N4 - mTy - Deptoere - --.-Total length--------- ---------------------- le --------------------- Seepage Pit: Distance to nearest well----------------------Distance from:,11�undation-----------.--------Distance to nearest lot line----------------- ❑ Lining material. 4 __. -Sii: Diameter------ Depth lumber of pits 'z � l I Cesspool: ,,Distance from nearest well--------_---------Distance from foundation___.____----______.Lining material------------------------ Depth Liquid Capacity---------------------- gals. ❑ Size: Diameter------------------------------- - Privy: Distance from nearest well-----------------------------`----------------- -Distance from nearest building_______-_-______------------------------- ❑ --- --------- ------------------------------- ,-i--- - { pistance to nearest lot line-------------------------------- 4 -- -------- in Remodeling and repairing (desi7Ebe)------ ------------- - i _. ., .. ,, -- r ----------------------= --------------------- I ---- --------------------------------------- -- -- ------------------- ---------•------------------------------------- ------------------------- ------------------------------------------- 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 ad regulations of the San Joaquin Local Health District. �-- ------------[0waa=z=dAr Contractor) --- ------------------- � -- (rtle} / Gy ------- - ----------- -------- (Plot plan, showing size of lot, location of s in relation to wells, buildings etc., can be placed on reverse side). FORS-EP'ARTMENT USE ONLY -- ti� ,i APPLICATION ACCEPTED BY------- `---0-'----------------- ----------------• ..........1- DATE 7� `Z�J 9 REVIEWED BY--------------------------------------------=------------------------------------------------ ---------- I-------------------- DATE------------------------------------------ ----------------- '11'---------------- DATE-----------------------:------------------------------------- Alterations and/or recommendations:----BUILDING PERMIT ISSUED_-----•--------------------------------------------- ------------- - ----------- u---------------------------•----------•------•-----------•-------•-------- -------------------------- til ------------------------------------ ----- ----------- ---------- ------ -- --- --- - ---------• ----•----=-; - ---------------- --------- ----------------------------------------- i g--1-:----�o. FINAL INSPECTI --- - --------- -------------------------- Date------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 914 North "C" Street 130 South American Street 300 West Oak Street �,�132 -S yeaoiore'Street * 3 ITrac California ! Stockton, California Lodi, California.,._. Manteca, California t Y. FS-92M Revised$-'59 F.P.CO. ,