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Permit No.� APPLICATION FOR SANITATION PERMIT / •---•----- ;---- (Complete in Duplicate) 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 Ordinance No. 549. JOBADDRESS AND C TION- -- --------- --- --- - ----- ---------------- ---------------•-------- --- Name------ = . 1�� - ----------- Address -------- one. ---------------------------- Owner's _ i Address f'a'__�-- ---/� ---- -------------_----------- -••---------------. ------ Phone----------------------------- Contractor's Name-------------- _ f Installation will serve: Residence �partment'House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t r�i, I f Number of liv'sng units: _- __. Number of bedrooms __�_�-Number of baths _�__ Lot size --- ird_._-_ - - -_____.__--+_,_.._ r Water Supply: Publicrsystem U500 Community system'❑ ''Private ❑ "Depth to Waterjable ft. �. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑� Clay Loam ❑] Clay-[] Adobe �ardpan ❑ s E Previous Application Made: Yes ❑ No"[ --`N`ew Construction:, Yes �o ❑ FHA/VA: Yes 1 "-No❑. TYPE OF INSTALLATION AND SPECIFICATIONS: t 1 (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) p -. _ _ - A Distanceom neaestwk_ _:.__ -_-Disarfrom foundation---Tanka No. of compartmef - __-- _ _ 'Size___ tyLi uid de A --- ---4 - r . Distance from nearest,well--:---- Distance from I ��- - �/; 1, / I Disposal Fuld: � om foundation__y_____________Distance to nearest lot linel/49_1______ r Number of lines----.'�____--___ _____ Length of each line------o2-- / Width of trench__._ _ Type of filter material_ _ De th of filter material_ �� Total len +h_!,._.__ _ ----• 1 ia_ ,�_ p , , 5 Seepage Pit: Distance to_nearest well------ --- " ____'Distance ffom oun ion___ --' fir to nearest lot line_-��___/ [ � Number of pits___--f_____`____ Lining materia�4� e:'Diameter__ 1 ------------Depth_ is Cesspool: Distance from near!est.well____.__--:__'__.-Distance from foundation_=---:--__.--_�--Lining materia---------------'---',--,' = ❑ Size: Diameter._=_.' ------------------------- Depth----`- ----------------------------- ------ ----Liquid Capacity gals. ' Privy: Distance from nearest well-----------------------:_.__:__-_-------------Distance'from nearest - Privy: ❑ Distance to nearest lot Eine ". . gym.. . �----._. „- �i _Remodeling and/or -repairing (describe)------------- - -- - � N . ----- ---------- --------------------------------------------- ?•---- x ----- -- a - -- - ------------------- - --------------••---------------=------------------------------------•----------_- ---------------------------------------- ----- - --- _ _ ____ ------------------------------------------------------ I _ _ _ _ __ Y _ _ _ _ _ ______ I herebycertifythat-1 have re ared this a lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulati ns of the San Joaquin Local Health District, q y nr ct (Signed) R,� "� """"----- ------ ------------ -------- - ] . " aJ� 'g' {Title] �i/W a t a or (Plot plan, showing size of lot,'locati f s stem in relation to wells, buildin s, etc.; can'be laced on reverse e). FOR DEPARTMENT USE ONLY } . :..,`. 417 APPLICATION ACCEPTED BY--:-------------------- -- ------------------------------------------------ DATE: -•--- - ---------------- f � REVIEWED BY------ ---------------- --------------------- BUILDING PERMIT ISSUED--=-.-- ------ - �> ---------------=----------------------------------- DATE ----- ------------- ------ ----- ------. " Alterations and/or recommendations.--------=-- - ----------------------- 1 ------ ------------------•• �� - T___ O "la --- .........L1��-C_�-------C7/ :G -- 7�41V e1;--- �r � -------- / i - ----------- X107 ------ ----------------------------------------- - L_ r - ' [ f�• �• - FINAL INSPECTION BY:._:.- ----- - sE+{-- ------I------------------------ -' ••- Date=-`-----�-.---�i- ------�'"�-----=�---------,� -.,-._ . SAN JOAQUIN LOCAL HEALTH DISTRICT - 130 South American Street I 300 Wes* Oak Street , r* 132 Sycamore Street 814 North "C" Street •'Stockton, California Lodi, California Mlanteca, California, Tracy, California 3 ES---9-2M Revised 1-57 F.P.CO.