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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Du licate) bate lssZ ),2tD . - 6 6 z� a Health I %- _P\1 H &-t K A cal s Application is hereby made to the San Joaquin Lo District fo a ermit f co truct and ins the wo herein scribed. 's application is Made in complian with c unjtyrdTiage.. 49 JOB ADDRESS A LOCA ,10 - ------(------- ---- - - ----- ---------- ---------- ---------- Owner's Name-------- - - -- ------- - -------- --- --------- ------ --------- -- ---------------- - ------------------------------------------ Ph kn e )V�D-_st_rk7T — Address-------51--- -------- ---- 1 - -f 7. 3...../70-2,6.... -------------------- Contractor's Name-- --- - ------- -- --------------------------------------------------------------------------------------------------------------- Phone----•---• ------------------------- Installation will serve: Resident Efr' Apartment House El Commercial El Trailer Court El Motel ❑ 0 ❑ Number of living units: ---V- Number of bedrooms 3--- Number 9f baths _Z__ Lot size ---- ------------------------ A� / Water Supply: Public system E] Community system El PrivifPCO' Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam El Clay El Adobe E] Hardpan El Previous Application Made: Yes,E]. No E] New Co6strucfion: Yes [:] No D FHA/VA: Yes Ej No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pU61j'c`Sewer is available within 200 fee�.) Septic,Tank: Distance from nearest well-Si, _,-�istan fro n) f d fioriz�afer�ia - ------------------------- No. of compartments----------- ------ 0 1 SiTe.I---------I----------------Liquid Oep.th--- ---------- -----------Capacity---- D;spos.E�/Flelcl: Distance from nearest well--50"�___ isfance from founclationl istance to nearest lot line Number of lines f each line------ Width of french----------- th-------------5�_,V---- ---6-1------ ------- - ----- Leng" 0 Type of filter m .1 pth of filter material--------- _____.____Total leng r" 't'ne Seepage Pit- Distance to nearest w 11------- Di from foundation--- ------Dista�nce to nearest lot line______________.__ ❑ ine----------------- El Number of pits----------------------Lining material---------------------..Size:Size: Diameter------------------------Depth----------------------------__.- I I Cesspool: Distance fLom,nearesf Distance from foundation-,,-,--,.--,,-,-_.,Linin -------------------------------------- Size: Diameter--------------------------------------De pth_!--------------------------------------------------Liq ,d materialCapacity----------------------------gals. Privy. Distance from nearest well-____________________________ __________________Distance from nearest building_______----___._______________________. Distance to nearest lot lire------------------------- ----------------------- --------------------------------- Remo Klin and,/or repairingf de i6e):--------------------------------------------------------------------------------------------------------------------------------------------------------- - --- --- - ------ -- ------------------------------------------------------------------------------------------------ ---------------------••-------- ------------------ -- -----------L ---- ------ja�-------------- ---------- -------------------------------------------------- -- --- ------ -- - ----- --- --G ------4-a.4 -------------------------------------------------------------------------------------------------------- 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 and regulations of the San Joaquin�i Local Health District. (Sign ----------------- ----------------------------------------------- --------------------------(Owner and/or Contractor) By:------------------------------------------------------------------------ I-------------------------I-----------------------(Title)----------------------------------------- ---------------------- i (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -------- ------------------------------------------------------------------------------------ DAT4 ------------------ ------------------------------ REVIEWEDBY------------------------------tN------------ ------------------------------------------------------------------- DATE— ---------------------------------------------------- BUILDING PERMIT ISSUED--------- _ -- ---------------------------------------------- DATE-- - -------------------------------- Alterations and/or r ommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- 401 --------74------------------- ig -,*---- , , ------------------------ - -------- -- ---- ---------C----------- ---------- ----------------------- - ---------------------- ------ ---------------------------------------------------------------------------------------------- 7------- ------------- ------com-EK------- -------- ------- ----------------------------------------------------- -------------- XX RC FINAL INSPECTIO ---- ------ Date----------------- --I------- 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-9-2M Revised 1-57 F.P.CO- It — 1.