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ems- _y f�J — APPLICATION FOR SANITATION PERM."� - Permit No. f Z (_c f o P M (Complete in Duplicate) Date Issued ______/_ -34.O f This Permit Expires 1 Year From Date Issued 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 comL liance with County Ordinance No. 549. 1EU JOB ADDRESS AND LOCA - ---------------------------------------------------------------------------------------•-------- Owner's Name.---------- -- - -------------------------------------- - -------------- ----------- ---------- Phone------------------------------------ V -------•---------------------------------------•---------- Contractor's Name-------- '--'- _ n:� -------------------------------------------------------- `-- ----------------------- Phone.-.----------.------------ -- Installation will serve: Residence �I�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j____ Number of bedrooms Number of baths _/--- Lot size .42) X-_//p--- --------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table /ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 20_�lardpan ❑ Previous Application Made: Yes ❑ No �New Construction: Yes �No ❑ FHA/VA: Yes Z�--No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ Septic Tank: Distance from nearest well---rr-----Distance from foundation---/Q--------.Ma ia�--------�--- 2------------ No. of compartments____ _ __ -____.- Liquid depth__.! _.___._____Capacity____ .__ Size_ i / Disposal Field: Distance from nearest well.______"--'__.._.Distance from foundation___�Q_.__...-.Distance to nearest Number of lines------ -----__ Length of each iine___y,9`______________-Width of trench.__ j/!/I--_____-______-__ ---------- Type of filter materia _ �� yp ��,�i.�c��.�.'_Depth of filter mater,al----��-----�---Total length------- --,Q----- ------------------------ 01 -----------------�-- ^� Number of its....�______________Lining material-- �ation____�0____---Distance to nearest lot line__-�._____ Seepage Pit: Distance to nearest well-.---__________ p Distance yp&--^-Size: Diameter_��f.______.Dept h_-Z------------�f�X_! Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____________________________-. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------------------....gals. Privy: Distance from Nearest well ______------------------------------------------Distance from nearest building--------------------------------------___. Distanceto nearest lot line----------------- - --------- -----------------------------... ------•-----•------------ ------•---------------------------------------- 'Remodeling and/or repairing (describe):---- ---- - -- ------ -- - --------------•---------------------------------------------------•--•- -------------------------------------------------------•---------------------------------------------------•---------------------------------------------------------------------------------------------------------- ------- F 1 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 r les and regulations of the San Joaquin Local Health District. (Signed)--------------------=- ;15- --- --------------------------------------------------------------(OwY r-Contractor) B y -- ------- -- -- --- -----------------------------------------(Title}---- - �---`_ (Plot plan, showing size of lot, locationoKxsf em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- --C--^ - ------------------ ----------------- DATE------Y a-3--'_6_0----------------------- -REVIEWED BY---------------------------------------------- --------------------------------------- -------------------------------------- DATE-•---------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------•----------------------------- DATE------------------------------------- ------------------...- Alterations and/or recommendations:-------------------- -- --------`---- ----------- ------------------------ T-- = -------•-------------------------------•-------------------- -------------------------- ---------------------- FINAL INSPECTION/BY ,��- Date----------------------------------- ---------------------------------- ✓ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 SouWr merican�Streef 300 West Oak Street. 132 Sycamore Street 814 North "C" Street pit Stockton, California Lodi, California a.� Manteca, California Tracy, California a ES-9-2M Revised 8-'59 F.P.Co.