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-fl, APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 114 Date Issued --- 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 Ordi nce No 549. JOB ADDRESS AND LOCATION._- ------------------------------------------------------------------------------- Owner's Name-------------- ------ --- - ------- ---------------------------------------------------- Phone----------- - Address -- ------------------------ V- 47m--__,� -------------__----------------------------------------------------- ------------------------------------- ---- --- -- -- - ------------------------- ---------------------- ---------- Contractor's Name------------- �_ r -------------------- Phone------- Installation will serve: Residence Er"'Aparfmont House E] Commercial F1 Trailer Court Ej Motel 0. Other E] Number of living units: _A,N ber of bedrooms Number of baths _--te Lot size ---------------------------- Wafer Supply: Public system ��Cllmunify system E] Private-E] Depth to Wafer Table 4w1f. Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam 0 Clay Loam E] Clay 0 Adobe [?4— [j Previous Application Made: Yes E] No ;�PNew E] Sandy Construction: Yes E] No. FHA/VA: Yes [] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 fe9f.) "X Se t'c Tank: Distance from nearest well-__-______---.--Distance from foundation_---_--- -.Matq No. of compartments---------- prial----------------------------------------------- ---------------Size--------------------------------Liquidc p r.pfh---------V` .. ;1 M -------------Capacity----------------------- 'floDisposal Field; Distance from nearest well,-..---—----.-Distance from foundaflo -- --------------Distance to nearest lot line---hl-7- Number of lines________ ____- -Length of each line----- Q---------------.Width-- of french.--- Type of filter material- Depth of filter rnaferial__.__,/ -------------Total. length-----j?t7_1----------------------- See 6-N+- Distance to nearest well----------------------Distance from foodatior _14e�----------Distance to nearest lot line-4----------- .115 TIA Number of I pits-----4-------------Lining material--- Diamefer_kA(ep......i Depth-------trr__-/---------------- Cesspool: Distance from nearest well-----------------Distance from foundation--- ----------------Lining malerial------------------------------------- El Size: Diameter---------------------------- ---------Depth--------------------------- ------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well______________-__-- _-_-----Distance from nearest bu;1ding--------------------------------------- -- 0 Distance to nearest lot line_ ------------- and/or repairing (describe): -- ----------------------------------------------------- ----------------------------------------- Remodeling and ------ -------a __ __ I 2kX!e4 — --------------------------- --------r------- ----------- ----------------- --------------------------------------------- ----------------------- ----- ------ �4zz------/------------ -------- -------------- ---------------------------------------- ---------------- -------------------------------------------------------------------------------------------------------------_a�---- ----------------------------------------- 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 d regulations of the San Joaquin Local Health District. (Signed)--------------------- ----- . . . ... By:------------------------------------------------ -------- --------------------------------------------------------------_(Owner and/or Contractor) (Plot plan, showing size of lot. locati --- ------------------------------------( j----- Title-- - ------ ----------------- f system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY______________________ --------------------------------------------------- DATE-_____-_ -------- -------------------;----------------------------------------- DATE REVIEWED BY----------------------------------------------- ai BUILDING PERMIT ISSUED Alterationsand/or recommendations-------------------------- --------------------------------------------------------------------------------------------------------------------------------- ------------------------ -------------------------------------------------------------------------------------------- ------ ------------------------------------------------------------------------------------I------------- ---------------------------------I- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------- ---•-------------------------------• -------11------------------- ------------------------------------I---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------I-------------------1---------- ------------------------------------------------------------------------------------------------------------------------------------------ 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 ES-7-2M Revised 1-57 F.P.CO.