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APPLICATION FOR SANITATION. PERMIT Permit No. (Complete in Duplicate) Date Issued ----1�191 h�- A gplica4ion ,is here6y 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 NLeL o 49 .013 - ------------ �7, - -" M'_� .... -t0CA , N------- ---- JOB ADDRESS AND �Tf ----------- ------ ------------------------- Owner's Name----- ------------ ------L---- --------------------- ------ - - -------------------------------7-7. Phone ----------------- ----- Address----- C Contractor's Name--- - P hone-/ M, Installation will serve: 'Residence P3 Apartment House El Commercial E] Traile-r Court E] Motel El Other E3 Number of living units: Number of bedrooms Number of baths ___f___ Lot size ------- g--Y------------------------ Water Supply: Public system Community system El Private R Depth to Wafer Table 0 feet: Sand F Gravel Fj Sandy Loam Fj Clay Loam [I Clay, E] Adobea Hardpan E] Character of soil to a depth Previous Application Made: Yes 0 No X_ New Construction: Yes a No E] TYPE OF INSTALLATION AND SPECIFICATIONS: A (No septic tank or cesspool permitted if public sewer is available within 200 feet.) < Septic Tank: Distance from nearest well---/1&��Disfance from founclation--YAO------------Material.... - ---- -- -----------Size--15- No.. of compartments......C:�5-1 Liquid depth.......W-6-"-' .........Capacity------5- - --------- le 1- lot line--- Disposal Field: Distance from nearest well--/(j&rL4 --- ---------Distance to nearest /4�------ m' ber of lines. well--/(Dr+ Distance from foundation ----------------- !••- ' *--------------- Nu NJ -------- ---------Length of each line--------_ --0,---fir----Width of trench.----- i Type of filter material--- ------5-ADepth of filter material-------/-X--------Total length--------_e*e--------------------- Seepage Pit Distance to nearest well_-. Ce d -.Distance to nearest lot line------4am------- �istan from ok(n (?f'on-------------- 11 &1-4 -----75575.i7_-------.Depth-__- ----------------- Number of pits------I-------------Lining maferial--C------- ZI: Diameter. Cesspool, Distance from nearest well-----------------Disfa nCe from foundation--------------------Lining material__._----_---_____----___________--___. ❑ aterial----- ------------------------------- El Size: Diameter----------------- ------------------ Depth-------------------- --------------1iquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest bu.ilding------------------------------------------ ElnDistance to nearest ]of line--------- ------------------------------ --------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):--------- --------------------------------------------------------- ----------------------------------------------------------------------------------•- ------------------------------------------- ------------ ------------------------------------------- ---------------------------------------I-----------------I----------------------------- -------------------------------------------------------------------------------I----------------------------------------------------------------------------- ------------------------------------------------ --------------- . I I hereby r certify that I have prepared this application and that the work will-be done in accordance with San Joaquin County ordinances, State aws, and rules and regulations of the San Joaquin Local Health District. (Owner and/or Contract ----------------------------------------------- -- ------------------ (Signe d)..........I------------------------- ILI----------- ----------------------------------------(Title) io' of system in relation to wells, buildings..et c., can be placed on reverse side). (Plot plan, showing size of lot, location FOR DEPARTMENT USE ONLY APPLICA TION ACCEPTED 7BY------ -------- -------------------------------------------- DATE----e--------------------- --- ----------------------------- ------------ ------. DATE--- ------- --- --------------------ix---------------------- ? DATE - REVIEWEDBY--------------------------------------------------------- ------- - ---------- DATE.---- ----- BUILDING PERMIT ISSUED..................................... . - - ----------- Alterations and/or recommendations:--------------------- .... . -------------------- -------------- ------------ -------- ------- ---------------:-------------------------------------- ----------------%------------- - - ------------------------------------4----- ----- I------------------------ .Z, --------------------------------------------4��------------------------------------ --------- - T - ----- - ------------ ---------------------I-------------I------------------------------ --- --------=:- ------- - -0-------- -------------------------------- --------------- --- ------ .u-------- - -------- ------- --- -------------------- ------------------------------------------------------------------------------------------------------------ -------- ------------------------- --------- -< FINAL INSPECTION'BY-.-1` -,,4j-.--(;----------------------------------- Date— 5 --------------------. 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 CC 0 ')kA w-iinr)