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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date issued Application is hereby m -A- - 4-k- c- I ___I L I 1A — , - . I . This application is mad JOB ADDRESS AND Owner's Name_gvl rein-deSGr-ibed—, ------------- Address - --- ---- - ---- ��--�-- ---- �----��---------.�--- �- Contractor's ------------Confractor's Name ------ --------- ----- ---- -------------- ---------------------------------------------------------- -------------------------------------------- Phone-------------- Installation hone --------------- ----------- --------- er 7, Installation will serve: Re �idene 0 Apartment House E] Commercial 0 Trailer Court E] Motel 0j Other If wrv. IF . k4� Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size _ __R ---------- - -- - -------------- Water Supply: Public system El Community system [:] Private El Depth to Wafer Table J ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Ej Clay Loam E] Clay El Adobe El Hardpan E] Previous Application Made: Yes [-] if No Or New Construction: Yes LN No E] FHA/VA: Yes E No EX TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or' cesspool permitted if public s�cre is lab within 200 feet. Septic Tank: Distance from nearest fr." f,� 1�arest woell ------- r__�Fislan',__e fro found on_______ --_____Material____ --- -------------- No-of compartments---__ . . ... Size- ---- ----- Liquid depth Capacity ----- Ran)----- -=-`"' Disposal Field: Distance from nearest?ell--------'---.-.Disfance from foundation ---- 1�cj ------- Distance to nearest lot lin ------ - FV Number of lines ... Length of each line------%A-d-----------Width of french-. -k� Jpq Type of filter m & It ------- Total length ------ ) ------------ ---- aferial --- 5-t-i--i"150-kepth of filter material --- /-,( 49--0 Seepage Pit: DiOance to nearest well ---------------------- Distance from foundation ---------- _ -------- Distance to nearest lot line . El Number of pits ---------------------- Lining material ----------------------.Size: Diameter----------------------- Depth --------------------------------- Cesspool: Distance from nearest well_________________ --Distance from foundation -------------------- Lining material -_----._____________---------------- -1 1- F Size: Diameter--- : ------------------- - ---------- Depth ----- - --------------------------------------------- Liquid Capacity_-- ------------------------ gals. Privy: Distance from nearest well -- ----------------------------------------- - -- Distance from nearest building ------------------------------- ----- �� ❑ Distance to nearest lot line ------------- Remodeling and/or repairing (describe)________________________ -- I --------------------- -------------- -1 ---------------------------------------------------------- i. --------------------------------------------------------------- - -------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- I ---------------------------------------------------------- ------------------------------- ----------------------------- ------------------------------------- --------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- -4-1 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat 0aws. and rules and regulations of the San Joaquin Local Health District. Z (Signed)-- 41 ----- ---- a-11! ------------------------------------------------------------- (Owner and/or Contractor) By%k 4 -- ---- -- — — ------------- (Title) ------------------ _ ------ (Plot plan, showing size of lot, llocations--- ofsyst,Zn relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•- `------------------------------------------------------------------------------------- DATE- ------ REVIEWEDBY-------------=---------------------------------------------------I ---- ------- -:-,e - ------------------------------ DATE---- --- - ------ --------------------- - BUILDING PERMIT ISSUED ---- ------------------------- - - ------ - - -------------------------------------- DATE Alterations and/or recommendations:-, ----- ------------------ ------------------------- --------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ ----------------------- I ----------------------------- ------------------------------------------------------ ---------------------------------------------------------------------------------------------- ----------------- ------------------------------ ----------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ------------------------ ------------------------------ ----------------- ---------------- •-•------ -------------------------------------------------------------------- FINAL INSPECTION BY----------------- Date ------------- j------------------ - --- 4ZAM I AnHIM LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore SfrW 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M . Revised 1-57 F. P. CO.