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t-Ali W� 6 0 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) A- This Permit Expires I Year From Date IDate Issued .__�---]Issued .; --- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein clescr1bed. This application is made in compliance with County Ordinance No. 549. ------------- ------ LOCAT]Ot� ---- JOB ADDRESS AN r1__1 'jt------------- 7 : ------- ------:!,7A —------ ------------- P h o n e.A-_,g� Owner's ..... . ........... ov, . ...... 7...------------ -------------_--------------- ---------- Name-------- Address------------------------------- -------------------------------------- ----------------- --------------------------------- Contractor's Name'- I ---------- //�C YAMGHT ------------------------------------------------------- - Phone-" A Installation will serve:ft,e9 Apartment House [] C mmercial 0 Trailer Court E] Motel [-] Other Number of living units- ____ --- Number of baths _1--- Lot size ----- -------- ---------I Number of bedroom. , 9�1. - ----------- Water Supply: Public system ff-- mmunify system E] Private El Depth to Wafer Table 670-ft. Character of soil to a depth of 3 feet: Sand E] Gravel 0 Sandy Loam E] Clay Loam 11 Clay El Adobe Hardpan El Previous Application Made: Yes E] Not --New Construction: Yes ❑[-] No- —FHA/VA. Yes ❑El No ❑Ej 4? 4 TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Pf ic TgKfv- Distance from nearest well-----------------Distance from foundation-------------------Materiai------------- ------ --------------------------- F,C No. of compartmenfs--------------------------Size--------------------------------Liquid depth----------------- --------Capacity----------------------- I�d: Distance from nearest well..M-n°!1—Distance from foundation___e - to nearest lot line---- Dispos,,,�e rest Number of lines------I------ Length of each -------Width of french-----ra- ---------------------- Type of filter material -------- Depth of filter material.___--_1° length-_.(00____________________________ Seepage Pit: Distance to nearest well_jA_ra*P-----Distance from foundaticim-1-0-------------Disfan I ce to nearest lot line------" ------ 0------ �C ' Number of pits---J_---------------Lining material---K 0-115------ Size: Diamefer__Z,�.... Depth---,.&-- ------------------ Cesspool: Distance from nearest well-----------------Distance from foundation_______-----.---.-. Lining material--_.______-___________________-______ ❑ aterial------------------------------------- I] Size: Diameter--------------------------------------Depth-----------------------------------------------------Liquid Capacity-----------------------------gals. Privy; Distance from nearest well--------------------------------------- ---------Distance from nearest building____-________----------------- ---------- ❑ Distance to nearest lot line----------------------------------------------------------- ----------------------------- )----------------------- - 5 .1 -__� r --- - ------------------------------------------------------- Remodeling and/or repairing (describe):- --------- -------------- ....I.,---------- ------ ------ --- ?------------- -- --------- --- -------- -------------------------------------------------- -------------- ----------L--------=--- ------------------------------------------------------- ! --------------------------------------- --- I--------------------------------------------------------- ------------------ --- ----------------- ------------------------------------------------------- - I herialoy.-cerfify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health eDistrict. r. IDAY (Signed)------- --------- ----------- -------------------------- -------- -914IGHT------- ------------ -------- -------(O or Contractor) OPfic Tank Servicts By: -------------------NQ ---------- ---------------- ---- --- Itle)------------ ------------------------------------------------ (Plot ---I.....(Plot plan, shoome of lof-JOA& Wes 01n. in r ion to wells, 6 ings, etc., an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -1-—------------------------------------------------ DATE---------- qs -------------------------------- REVIEWEDBY------ ----------------------------------------------- -- -- ------------------------------------------------------- DATE------- -%- -- --------------------------------------------- BUILDING PERMIT ISSUED----------------------------------�T-------I--------------------------------------------------------- DATE._-------------------------------------------- --- Alterations ATE---------------------------------------------- --- Alterations and/or recommendations-------------------------- --------- -------- ------------------------------------------------------------------------------- --------------------------------- -------------- //- ----- --------------------------------I---------------------- -- ------ ----- -----------44- -------------------------------------------------------------------------------------------- ------- -- ------ -------------------------------------------------- ------ -------------------- ----------------------------------------------------------------------- -- ------ --------------------- ----- --- ---- ---------------- ------ i--- --- ---- -------------------------- --------- ------ - -- ----- ------------------------------ FINAL INS-RECT.I0-N-0�'.. -2--- ------ Date----A91___r_?_377------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised V59 F.P.Co.