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Sol- APPLICATION FOR SANITATION PERMIT Permit No. _ 5 -- i�✓" (Complete in Duplicate) - _ Date Issued Application is'hereby made tothe S'an Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County(Ordinance o. 549.i i aI#"� JOB ADDRESS A� LOCATION_��•�-- -----_--�'�----- ---- a \ P_____ _________________ ' i Owners Name______l TM� - - - n Address---------- f --- -- •. - ---- -----------------------------------•---------------------------- •----------- Contractor's Name___-- f �' "'� `' .... - ---------------•------------- '----------------------- 3-_ -------- P one-- Installation will serve: Residences Apartment House ❑ Cercial I J ❑ Trailer Court ❑ Motel ❑ Other ❑ ! Number of living units: ___,_*_iNumber�of bedrooms _ umber of baths ___�__ Lot size __� h---A f= -- 40--------------- ------------- Water-Supply: Public stem y ❑ Community'system'❑ Private ❑ ;Dept to Water Table ft. Character of soil to a depth of 3 feet:: Sand ❑ Gravel El Sandy Loam ❑ ClayClay ~ s Loam ❑ � y ❑ Adobe� Hardpan ❑ Previous Application Made: Yes No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ . TYPE OF INSTALLATION AND SPECIFICATIONS: 1. ► I ' (No septic tank or'cesspool permitted if'public sewer is available within 200 feet.) rep No. of compartments-_: —� M T r T ` µ~T r a. ..� Se tic Tank: Distance from nearest well Distance from,foundation_ ------------Mater P . Sq �E Liquid depth Capacity- Disposal 'Field: Distance from nearest- — ' Number of lin01 es____ '_ ' -__* Length e from foundation - : Distance to riearest lot lin of each line____ -- D � . �. ..-----Widfh''of trench__ .�.�--- ----------------- ------ e th o we _--------- -.Distance Type of filter rriaterial__ � p R f fil#er materia _ _-Total length------_rG9------------- Seepage ______ s �Seepage�Pit. Distance�.to nearest efl�` �— -�'*- )� piatance from.:f0 d"t.ion �._-__.Distance to'nearest•lot ii Vie_ :ter Number"of pits �' " Lining"material_,�1yize: Diameter_ -f3_� ---___ Depth-°__ ^-' f----- J. [// Cesspool: , Distance fro .nearesf well --____Distance frgm foundation.:. =_=.Lining materia!----------------------- 1__ ❑ ❑ _. , Sizer Diameter------ --i-,t up . - Depth__-- "# ;w Liquid d C"a acit Yt . . raw1, 16 -- _ } 5als.Privyi Disrw --------------_._Distancefom nearestbuiidin - - ne;-Distance to nearest lot li E1 Remodeling and/or repairing (describe] A. Tim: -- -- --_____ : _- i _ . i F .. A a ' _ _ - .. A . 4 . A. -.. „s hereby tate lawsand rules and reg --------------•-----------•------------------- = = - ` ------- -------------------------------------------------- ----------. that I have prepared Ais-application and that the work will be done-in accordance with San-Joaquin County ordinencesulation$ of the San Joaquin,-Local Health District. (Signed}-• �- `�— L 1�5 - ----- $-T 4 (Owner j - -- --- -----•----------- r an ontract By------------------ - - .I-f4_4 - . - it --•-•-•----------- •- ------•_---------------------------------- _____ -_ ne /or C or} (Plot plan. showing size of lot, location'of system in relation to wells, buildings,`etc., can l°e placed on reverse side). FOR'DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-______`------r----- ,.----- ---- ----------------------------------------- DATE-- = REVIEWED BY---------------------------------- ----- DATE �-- BUILDING PERMIT ISSUED________________________ s DATE. - Alterations and/or recommendations:---'___-_.___-_= f_ I ' ---------- k p-� _ i✓ --------= �' �? ---------------------------------------------------------------- - ------ ` ••---- -!- -----•---------------------------------------_--- ---- --- ------•----------------------- -- ----- ----y----------------------- ----•------------ ------ ---- -----•--------------------------------- FINAL INSPECTION�BY: _. -�•��_- • - -.-------------- ---------------- -------- ---------- .. .. ,x'E -mak ----------- - ",..`-..- - 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 1:5-9-2M Revised 1.57 F.P.CO.