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APPLICATION FOR SANITATION PERMIT. Permit No. .f-Q__•z_( �p- u (Complefe in Duplicate) - Date Issued J__O//-I/-A 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-_N_ 35 ��oy +20-s- zo7 y y.7z 3" I a ------------------ f J--------------a-------- ------S -- -------- Owner's Name----w:------- ~-; N L1tiG i ---------------- ----------- Phone-- 5 Address------------------------------------------- �`4 --------LJ------g ' - -------•--------------•---------------------------------- --------------------------------------- Contractor's Name------------------ !4. - ! --------------------------------------------- ---------------- Phone---•------- Installation I. will serve: Residence [Y Apartment House ❑ Commercial ❑ Trailer Cour} ❑ Motel ❑ Other ❑ Number`o (94 f living units: __.7_ Number of bedrooms _�___ Number of baths,-)-C Lot size !c$� 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 [-Rardpan 11 Previous Application Made: Yes ❑ No ["'New Construction: Yes ['No ❑ FHA/VA: Yes ❑ No E2�-- 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 --Distance.fro, foundation--_)-Q_____-_____Material-__W `IM No. of ccmpartments___Z--- - --------Size___ -_ Liquid depth ` --------Capacity----2--_-0-_-0- _---------_--_- - Disposal Field: 'Distance from nearest well- vim.-_Distance'.from foundatio_n___-/P-------_---Distance to nearest lot line__s-________ t , x' Q� Number -of lines Length,of:each_Il,ine - ------------Width of trench----- 2 ` Type of filter material____�"t'�_------__De Depth of-filter material_-_-_ tr p � '-------------Total length-----------1 --------------------- 6 Seelpage Pit: Distance to nearest well'--------------------Distance from foundation__..•---------------Distance to nearest lot line------- ---------- : � 0 Number of pits----------------------------Lining material__r_----------------Size: Diameter-----------------------Depth-------------------------- - r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------------- J �❑ Size: Diameter--------------•------------------- Depth---------------------------------------------------Liquid Capacity----------------------------gals. W IiA Privy: Distance from nearest weft-_,_______.---___--_---_- _------------Distance from nearest building ❑ Distance to nearest lot line__ _ --' Remodeling and/or repairing (describe):--. _--- -=--=-T-_- -: - — --� ----- 3 a : _4) -----------•------------------•---------------•-------------------------------------------•-- ------------------------- - ---------- --------•------------------------•------------------------------------------------------------------------------- ---------------------•----- ------ ------------------ I hereby certify that I have prepared this application and that the work will be donekin accordance with San Joaquin County ordinances, State laws, and rules andrere ulations of the San,,Joaqui oval Health District. (Sighed / (! --- -- ----; - --------------------(Owner and/or Contractor) # (PlotBY ----------- ---------- -------•-----------------------------q- - -( �Tale)-------- ---------------- plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I. APPLICATION ACCEPTED BY---- ` - -------- -- - ---------`--`-------------------------- ----------- DATE--------- REVIEWED BY - --- -T - _ - - - ----- ----- - DATE 1 BUILDING PERMIT ISSUED --------- ----------------- DATE ------------------------------------- Alterations and/or recommendations:----------_--------------------- =------ ---------------•----------------------------------------------- -------'-•------------------------------------------------------------- --------------I--------------------------------------------------------- ----------------------------- -------------- ----------------------- ------------------ FINAL INSPECTION BY_____ _ - ------- -- - ------ Date-- f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+reef 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E$i9•--2M • Revises 1.57 F.P,CO.