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APPLICATION FOR SANITATION PERMIT Permit No. 4 1 (Complete in Duplicate) Date Issued __11-3-,2`f 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. JOB ADDRESS AND LOCATION__A__,3_&]------ ------ N\-j , Owner's Name-------t---- --------�`+Swa_v. .. ...... . ..............--------- -------------- Phone - - ------- -------- Address - ----------------------- to Contractor's Name------ y----74n -----13 ------7a- vr-- --------------------------------------•--- Phon,3.40--- Installation will serve: Residence UB-'�Apartment House 1-1—Commercial E] Trailer Court [3 Motel Other E] Number of living units: ___lumber of bedrooms&- Number of baths __�Lof size - ------j_47!P__f-------------- Water Supply: P'Ubli6.,'iystam-[ Community sysfem'E1-Priva-te-[]-Depfh_t6 WatJrTa'bG size '__ -_ Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam D 1Clay ❑ Adobe E] Hardpan E] Previous Application Made: Yes-E]-N6'0 New Construction: Yes 0 No ❑ FHA/VA- Yes Ej -.No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool 1p;r-mitted if public sewer is available within 200 fee+.) ptic T nk [Distance[Distancefrom nearest well_________________Distance from foundation--------------------Maferial------------------------------------------------ No. of compartments------- ----------*77i"size-------------------............Liquid clep�h----------------:� acit '-------Capy-------------------- P�1�% 11 I T *7 t. _1-.. ...._ i .�jsposa. elcl: I Distance from nearest well--('--(q>iip.lr,.Distanc'e from foundation-----1_6"___Disfancefo nearest lot line------ N,umber ofLength of each line__/D_'t-------Xvr,?_`-Width of french-------4�-4- ------------- Type of filter material_ Depth of filter mat9"ri'aIA/81V-- ----Tofal 16n�gfh-----cao��------------------------ Seepa e Pit: Disfancel nearest welljAarke '4-le from foundation_- ------_.Dist'anceJo nearest to Distance I lot line------S�------ Number of pits-:!!I ------__..__Linin'g maferial__R�C�--------Size: Diameter---Z/G'_'—_ ___.Deptk--------;1A—-------------- Cesspool: Distance from nearest well-----------------Distance from-foundation______________----- Lining material-------------------------------------- El Size: DiAet,r-------:-:'__*k------------------------Depth--------------------------------------------------_Li- quid Capacify--- ------------------------gals. , Size: ex 411, %OW , , Privy: Distance 'r&m neare�f well-------------------------------------------------Distance from nearest building__-_---__.___________._______.._ tQistance'"to uilding--------------------------------tl)isfance'to nearest lot lin --------------------------------------- ------------------------_---------------------------------------------------------- Remodeling--a--nand`/or--�--.--rr�-l..�ir ing: (describe):7-----1-1-1------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - II -F 17 ---------------------- ------------------------------------------------------------------------------------------------------------------------ ------------- I ------------------------------------------------------------- ------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I 6ve prepared this application and that the work will be do'ne*1n accordance with San Joaquin County ordinances, State laws, and rule and regulations of fha-Sauj7paquin Local Health District. # ---- -- ---- _V_dl----------------- Contractor) (Signed--------- --- -------------------- By:--------------------------------------------------------------------------------------- 2 --- -----(Title)---------------------- ---------------------------------------- (Plot plan, showing size of lot, location of system in.relatio Wells, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- - ---------------------------- - I DAT E--- REVIEWED BY ------------------------ ---------- DA' BUILDING - PERMIT ISSUED--------------- - ------- -------------------------------------- DATE.... ------------- - -- -------------------------------------------- Alterationsand/or recommendations-------------------- ---------- -------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------- ------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------- --------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ------------=-------------------- ------------------------------------- - FINAL INSPECTION 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 4- V> ES-9-2M Revisoo. 1-57 F,P.CO.