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APPLICATION FOR SANITATION PERMIT Permit Not --� •_ - " (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued -_-- ------ _G B Ap plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describ This application is made in compliance with County Ordinance No, 549. JOB ADDRESS AND LOCATION_ /F/-�• .. 4 C�- Owner's Name--- --------2..._. . __t�:�_=-__------ Ph------------------------------------------------------------------------ _ -- ---- --- r -- - - - ------- -.. o ne_. = Address _Arr ...i, ----------------------------------------------------------------------------------------•--------------------- } Contractor's Name_____'____-- t •----•---- --------------- Phone----------------------------------- Name- Installation will serve: �' Apartment House ❑ Commercial ❑ Trailer`Court ❑ Motel ❑ Other ❑ i !! '$ > Number of living. units-../--- Number of bedrooms _�"Number of baths____ Lot size ____..__" X PT ------------ Water Supply: Public sysfemg Community system �~ I Y st y ❑; Private ❑ Depth to WateifTableG_ ft. Character of soil. to a depth of 3 feet: Sand Grav�I y _❑MClay Loam ❑ .Clay ❑ Adobe 6Z1 Hardpan ❑ ❑ ❑•. 5and Loam /'i' Previous Application Made: Yes-K N New Construction: Yes j] No g] FHA/VA: Yes [] No V1 TYPE OF INSTALLATION AND SPECIFi TIONS: (No sejIf k or cesspool permute• if public sewer is available within 200 feet.) P nearest well_."---___-- --Distance from foundation-------------------Material___ ;_.--_--_ ` - e � aahk. ��Not of compartments -------------Size--------------------------------Liquid depth-'-----------------------Ca acit' ------------- Disposal Field: ", Distance from nearest well----- ` -"` Distance from foundation- /2!?71__--':Distance to nearest lot line-----S7------ YP bar of lines--------------- F Length of each line----------- --------:Width of trenclh------- ___Z - ------ T` e of filter material- __� - ` g �__ ______De th of filter material_.____ --_ Total len th-_-__--_ ___- _ SeepagerPit: Distance to nearest well----------------------Distance from foundationY_ _.'Distance to nearest lot line________".______ Number of pits = Lining material -------- ----- Size: Diameter-.:-------------------- Depth------ -------------------------- Cesspool: Distance from nearest well_________________Distance from foundation..._- ------------- material-__"-__...--------------- ---------- -__- - -- - ❑ Size: Diameter ----------Depth_._._ -- -------- - ------Liquid Capacity--------------------- ---•-gals. --- - -------- - d: 3 .. Privy: Distance from nearest we61-------------------------------------------------Distance from nearest building------------------------------------_--- ' ❑ Distance to nearest lot + line______._..______ s ="- _ ------------------ Remodeling and/or repairing (describe)__________________._.___._._._______ _ 3• ------------------------------------------------------i -"_____________-----____-_--__-_--_-____ ;' _ ____ _____ ______ ___ ____-_-"___--__-_._-_-_--__-_______------_- _ _ _ _ _ - . I hereby certify that I have prepared this application and that the work will be done in accordance .7 ----LCounfy y Y with San Joaquin ordinances, tat ws, an rules gulations of the San Joaquin Local Health District(Signed)----- --`--�-- (OwB :---------�- .----_-____ ________________._______- ________._(Title)_-___ � rter and/ i Yaa,�-cam - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - APPI KATION ACCEPTED BY. - <C --------------- DATE_-- _� - REVIEWED BY----------- - -------------------------------- -- DATE- --_ BUILDING PERMIT ISS_UED------------------------------------------------ ---------------------------------•------ ------------- DATE --------------._ _ ----------------------------- - ' { Alterations and/or recommendations:_ --- -------------------------------- •- - -------------------- ------- --- -------------------------------------------------------- ----------------------------------------•-------------•-------•----- ----- - ------------------------------------ ------------------------------- ------------------------ ----------------------------- -- "----------'------------------------------------ FINAL fNSPECTION 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 _ !,- ES-9-2M Revised 8-'59 F.P.CD.