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APPLICATION FOR SANITATION PERMIT Permit No. -..-..L .L�7......... <br />(Complete in Duplicate) -2 60 <br />CA - Date Issued 67__ <br />This Permit Ex gyres 1 Year From Date Issued <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />This application is made in compliance with County Ordinance No. 549. <br />L--- ----------- <br />JOB ADDRESS S�o Z- - -------------------------- <br />Owner's Name---- ------ 7 ------------------------- --------------------------- -_7 <br />Address------------------ ........... 3--b- ------------- --------------------------------------------------- ..................... <br />Contractor's ---------------- ------------ Phone( <br />Installation will serve: Residence x Apartment House E] Commercial [] Trailer Court E] Motel 0 Other 0 <br />Number of living units: J--- Number of bedrooms -3-- Number of baths _/---- Lot size t_?=_4 --------------- <br />Water Supply: Public system [& Community system El Private F1 Depth to Water Table.50- ft. <br />Character of soil to a depth of 3 feet. Sand [] Gravel El Sandy Loam Ej Clay Loam El Clay El Adobe, Hardpan El <br />Previous Application Made: Yes E] No 5;r-- New Construction: Yes El' NogL FHA/VA: Yes F1 No <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />ptiq T nk., Distance from nearest well________________ Distance from foundation -------------------- Material -------------------------------------------------- <br />I <br />­,%V.XjLej No. of compartments -------------------------- Size -------------------------------- Liquid depth-------------------------- Capacity-------------------- <br />S4?.l iell Distance from nearest w0_60_kie ---Distance from founclation._11' .......... Distance to nearest lot line____ <br />ell <br />Number of lines ----- --------- Length of each line____,Z --- 0 -------------- Width of trench .. ---- <br />0--/ ------------ <br />_444 Type of filter materi'li- -ke-J4 --- Depth of filter material-. .... length ------------------ ---------------- <br />Seepage Pit: Distance to nearest well -44.04.A - ----- Distance."frorg founclafion-_':40 ....... Distance to nearest lot line ---- c' - �5 ------- <br />Number of pits_ --A --------------- Lining material__Xr,.c� --------- Size: Diameter___,,,_3 Depth__2 I________-__ <br />Cesspool: <br />I--- --------- <br />Cesspool: Distance from nearest well-----, ----------- Distance from foundation --- ---------------- Lining material___.______._______.________--._-___. <br />0 Size: Diameter------------------------------------- Depth ----------------------------------------------------Liquid Capacity -- -------------------------gals. <br />Privy: Distance from nearest well- ------------------------------------------------- Distance from nearest building ------------------------------------------ <br />❑ Distance to nearest lot line--------- - - I - ----------------------------------- I ------------------- ----------------------- -------- ------------------------------- <br />-R--e--m---o--d--e--l-i-n--g----a--n--d--/--o--r----r-e--p--a--i-r--i-n-g----(-d---e-s--c-ribe): --------------- - <br />---- ------------- 2------------ ----- - ---------------------------- ----------------------- --------------------------------- <br />- <br />----------- ------------------------------------------- ------------------------- ---- ------ --------------------1-- Y -A ,_ <br />�----------- <br />- - ------------------------------------ ------------------------ <br />--- <br />-------------------------------------------------------- ----------------------------------------------------------------------------------------------------- <br />I hereby certify that I have prepared - is application and that the work will be done in accordance with San Joaquin County <br />ordinances, State laws, and rules and regulations ophe San Joaquin Local H th District, <br />— ------------------ !rf::i ----------------- (Opp smand0or-Contractorl <br />_-KZ'-J vc� <br />{Signed)-)_ <br />By: --------------_--- --------------------------------------------- __ -------- 16. -------- — -------------- ---------- ---- <br />-- - ---- - -- - ---------- (Title) ----- --------------- ' <br />(Plot plan, showing size of lot, location of system in rela o -to.-wells, buildin-Wetc., can be placed on reverse side). <br />171 Vor <br />USE ONLY <br />APPLICATION ACCEPTED BY--------' ------------------------------------------------ DATE ----- --------------------- <br />REVIEWEDBY------------------------ ............ ------------------------ ---------------------------------------------------------- DATE --------- <br />BUILDINGPERMIT ISSUED----------------------------------------------------------------------•----------------------------- DATE--------------------------------------- ------------- ------- <br />Alterations and/or recommendations--------------------------------------------------------- ---------------------- -------------------------------------------------------------- ---------------- <br />---------------------------------------------------------------------------- ------------------------ ------------------------------------------------------------------------------------------------------------------------ <br />FINAL INSPECTION BY: --------- <br />130 South American Street <br />Stockton, California <br />ES-9-2AA Revised 8.'59 F.P.Co. <br />q41_ <br />----------------- Date------ 1 ------------ --------------------- -------------- <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br />300 West Oak Street 132 Sycamore Street 814 North "C" Street <br />Lodi, California Manteca, California Tracy, California <br />�j <br />