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APPLICATION FOR SANITATION PERMIT Permit No. -ff.- �-- � �41, (Complete in Duplicate) Date Issued ----- �-S5__O 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 Orclinanc N, . 49. 9---, '� - JOB ADDRESS AND LOCATION-9-� Owner's Name--- ' r=--------,,1--- ------------------------------------}----------------------------------- ------ Phone--------------------------------•--- Address------ -----� --------------------------------------------------------------------•------------------------------------ Contractor's Name Phone----•------------------------------ ---- - Installation will serve: Residence Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _4777—b-7 of bedrooms _ '-- Number of baths ___1_ Lot size+ -X/L- --------------------------------------- x � Water Supply: Public system �Commuriity system ❑ Private ❑ DepfCto=Water Table Character of soil to a depth of�jeef: an ❑ Gravel ❑ Sandy Loam 'Clay Loam [I Clay F] Adobe Hardpan ❑ Previous Application Made: Ye i❑ No Fit-." New Construction: Yes ❑ N& Ejg-'PHA/VA: Yes ❑ No ©� TYPE OF INSTALLATION AND SPECIFICATIONS: Q No septic tank or`cess ool ermined if.p.ublic sewer is available within X200 feet. ' e ti Tank: Distance from nearest well--------j---___-Distance from foundation__--t_____-_______-Material__________________________-______._____--_--_-_. No. of compartments---------------- Size---------------- !Liguidepth*__!-------------------Capacity----------------------- ispos 1 ld: Distance fro#`m`nea est well_________________Distance from foundation____ _- Ditance to nearest lot line______________.. Number of lines_ ------------------------------- of,eacch I ne------------------------------Width of trench----------------------------------- Type of filter mater al ):--- _i________Depth of filter martef aL______________________Total length------------------------------------------ It If Seepage Pit: Distance to nearest well__ _ Distance f om and fion----/P--_______.Distance to nearest lot line__-_/_f�________- Number of pits._.__[r __________Linin material__ Size: Diameter_. �----------- �� ; 9Depth Cesspool: Distance from nearest well_______________-Distance from found�'ation___----------------_Lining material------------------------------------- Size- --___________________ -__Size: Diameter--------------------------------------Depth_ ---------------------- ------------------------Liquid Capacity -------------------------gals. Privy❑-. Distance from nearest well---------------------------- — -----:-.------Distance�from_n,earest building------------------------------------------ E ❑ --Distance to nearest;lot line-------- --------- - --------------------------------•------- `-------------------------- ' - - - Remodeling and/or repairing (describe):_.- ----------- -, q ,- ��k ------------------------------------•----------•-----;•_----------------------•-------------!•---------- ------------------------------------------------•------------------------------------------------------------------ . ------------- ---------------------------------------- -1 --=-=----------------------------------------------------------- ------•----------------------------------- --- lY --------------------------- ----------- --•------------ ------------ ----------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared thWapplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulati stof the San Joaquin Local Health District$, Signed ` _� ------------- ----------------( ontractorl F Sy:---------------- ------------------- --- o --- ----------------------------------------(Tit (Plot Ple} �Z,1�+ `" Ian, showing size of lot, locatio �sys;enn in relation to wells;buildings;eta cari'be'tplaced on reverse side]. s ` FOR DEPA NT USE ONLY APPLICATIONACCEPTED BY -- --------�11------------------------------------------------------- DATE-------------- ----- ---------------------------- REVIEWED BY--------------------------------- DATE-------- --N---------------------------------------------- --------- ------------------------- ---------------------------------------- BUILDING PERMIT ISSUED--------- ------------� - DATE------ --- ------------------------------------------------- ---------------- Alterations and/or recommendations_____________ - - --------------------------------------------------------------•---- ---- ----------------------- -------------------------------------------------------------------------------------- -------------------------------------------- --- FINAL INSPECTION BY.��_.l_ Date ---------------------------------- i AN JOAQUIN LOCAL HEALTH DISTRICT ------------------------ t t sA 1 130 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 1-57 F.P.CO.