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All � �•ei = ' - --- ---1 e A ' Y_ APPLICATION FO-R SANITATION PERMIT Permit No. .. .................... .......... ......................... (Complete in Duplicate) -- --- ----------------- This Permit Expires 1 Year�lFrom Date Issued Date Issued ___- Application is hereby made to the San Joaquin Local Healfh District Ifor a permit to construct and install the work herein described. This application is made in compliance with County Ordinan',pe No. 549. JOB ADDRESS AND LOCA KDN---- 5!( - ------------------------- w.. = ---- - Owner s Name--`----- ----".• ---� -- ------------ ----------------------------Phone.._.:----'--' Address- v Contractor's Name__ . .. � Phone------- Installation _#nstallation will serve: Resi ence-®Apartment.House ❑_.Commercial ❑ Trailer Court ❑ Motel ❑ Othr. r Number of living uni s: _-. __ Number of bedrooms __ - Numb.r of baths _ _- Lot size Water Supply; Public system 1311�community system ❑ Private ❑ Depth'to Water Table _ .q 1-7 Character of soil to a clepfft of 3 feet: Sand.E] Gravel E3Sandy 'Loam E] Clay Loam E] Clay ❑ Adobe :.'-':apan El Zj'�o ❑ Preyic us Application Made; {If yes,date.._.............. ) No New Construction:,Yes FHA/VA: Ye ❑ N o TYPE!OF INSTALLATIONf ND SPECIFICATIONS-. _ � ,. •. � -_-" ' P P ;within 200 feet.) No septic tank or cs ool ermitte . r °i Se tiC � /�-- -' _' anc from nearest Tank: NoDist of • ompartments `- - undation__ _ Materlal_ - /�� _E iquid depth --.._ . Capacityi / pis osal Field- Dis#ancf from nearest oundat' n_ _�-______ --.__.Distance to nearest lo# fe __..__. _ pFn __._._.Width of trench Iia+- Number of lines_--._ .... ,. Length of each-'<<= g e W- -- ---------- TYPP of filter material r Depth o{ filter ° �� r , Distance f om en th_/ , ._ ------------ �/ {_ ---------- --Number s Seep age Pit: D at -D ri e to nearest to t _._-_.- tier ._. _ Total I �„ • ,= -"Number of Its._.. _ Lin rig mate gal- __•:-� zea Diameter, p w .;- ,,tante to nearest weld- � J� I �is} rice { . 7- Cessn pool: DI }ante from nearest well..- ..._____Disfarrc>='from foun, - --------------- Lining mate�:ial--------- --� Size: Diameter._._- L3-jq. ---------- Depth �, --- Liquid Capacity-- .0.4 ----gals. Privy: . Distance; {rom nearest well-- .. . _ _. ------ ................Dist L -est building_ __` Distance to' __-.e „co�c�I IVI `�IIrG-' � ,•... - � \ IT�r' .�._ - i_. r�- L1- -/ ----------- Remo,deling and/or repairing describe):------------------------------------------------------------- -- -------------- _ ---- - '4 .- t/9 f ---------------------------------------------- -------- -------------- -----------------------------_-- --------------------------------------------- r . €hereby certify That ( hav prepared this application and that the work will,be done in accordance wth Sanj County I ordinances, State laws, and rul s,and regulations of the San Joaquin Local Health District. , E: {Signed)---------------------- --------- ..j� , tr ,;' tract or (Plot plan, showing size of lot, L-attan_,of sysfem.in_reI.a `�t0-wells, terse sid `r; L z � , FOR DEPARTMENT USE ONLY ✓r' - ._ DATE ; APPLICATION ACCEPTED __ ------------- REVIEWED BY------- -------- :: DAT ` UILDING PERMIT ISSUED------------------------------- ------ I Alterations and/or recommendations:._..___#._ �. A--3 . 'th =---------- ._w_a_ . A- u 4' r.i .................----------------- ---- ---- ------ -- - ---- ------------------ ----- — � r r � L --------------- -------------------- -------- FINAL INSPECTION BY:-----�`--•-- ---��--"`:------�---- ---• --------�--- Date...--�e-�-'---� -�----------- -- ------------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT T� 1601 E.Ha:ellon Ave. 300 West oak StLeet d 124 Sycamore Street,.',` 205 West 9th Street Stockton,California Lodi,California ! Manteca,California Tracy,California E5 9 REVISED B-59 3M 3-'63 F.P.CO. -