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~ y � ..t�_-_"�`g-�•-. APPLICATION 'FOR- SANITATION PERMIT Permit No. 5 (Complete in Duplicate) Date Issued `t '- `•-S� " This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin.Local Health District fora permit to construct and install the work herein described. This a "' licatiori.is made in comNli�r e ,with County Ord'n ce No. 549. J ..- U 1I �.. ._ -..1 �� -•,�'-- f, �� 1l. � �. JOB ADDRESS AND LOCAT N_--- _ :__�_ ..�1,- ... ----- --W:�d__D_u.I k-R-_- ------ ---------- -- S ----------- Owner:`is Name -------------- -i1J R' 's �� N Phone----------------`-- •---------.----- ,.a --ci/V f r Address---------'------------------------ -------------- - --------------------------------------------------------- - ----------------------�---•-----••--------------- Contrator's Name-- ---- Phone -- - - ------------------- ih l - - Installation will serve: Residenc16 e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Jt6,k 13J7 [Number of living units: ---___. Number of bedrooms�_�--- Number of batths _'f---- Lot size .--- !_---- --------------- ----------------- WaterIlSupply: Public system ❑ Community system ❑ Private)K Depth to Water Table --------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ SandyLoam i Clay Loam E] Clay ❑ E]Adobe Hardpan C15 Previouhs Application Made: Yes E] Nom New Construction: Yes No E] FHA/VA: Yes', ., No Eli TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool-permitte"d if public sewer is available within 200 feet.) Septi ;Tank: Distance from nearest well S._._..__Distan frornjoundation_---__-_._ �:�-- l� -Material - -- ------ No. of compartments-----.--- ._---.-_Size---- -A_ __X_J'_Liquid depth---------4---------€-Capacity--------•---- -------- Dis sal Field: Distance from nearer . i1 .._._.Distance from foundations:__'`f�______.Distance'to nearest lot line-._-s�--- P y Number:of lines__ _____�e `_... _-_______Length of each line____.___��------------------------------Width of trench------ --------------- D ________ Type of filter material- _Depth of filter,material___..--/-____..Total length_-_--_---__�_ _______________________ Seepage Pit: Distance to nearest well----------------------Distance fromifoundation---___._----_--_._.Distance to nearest lot line_--______---.._ Number of its Linin material-------------- Size:Diameter-----------------------Depth_____._----._.-- ____._._.._._._ ❑ pits--------------- - g } Cesspool: Distance from nearest well---------------Distance fromlfoundation._--_-:_..:__._.___.Lining"material;_.__...._._._._._._ ______-_.-...-. _ . i Pm a ❑ Size: Diameter depth --`--------------------------------- -Liquid Capacity-------------------- ------gals. -__-- _-_---Distance from nearest building Piny: Distance from.nearest well g Distance to nearest lot line---------------_--.--_-----...._ ii I i ( . Remodelingand/or repairing (describe):---------------------------------------------------------------------------------------------------------=-•---------••---------------- -------------- ----- - -------------------------------------------------------------------------------=------ • - vQ f, f ---------------------------------, __ ___.---------------------------------------------------------.-------------.-.-__-._-__._.__..--_----____-_.__---------------------------------------------!_____-.-..._._ �M --- -------'---------------------------------•---------------- ------------------------------------------------------------------------------ -----"`- I�hereby ify tha�I ave prepared this application and that the work will be done in accordance with San Joaquin County ordina es, S e laws, ides and regulations of the San Joaquin Local Health District. ; (Signe` --------------- -------------------------- �--------------- ---------------- ------------------------------------------------------------------(Owner and/or Contractor( --- ------- -- �f _ -------- --------------------- --- - -1 - - -- (Title)-- - - ------------------ y(Plot plan, showing size of lot, location of,system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYJ------------------ --- - - --- -------------------------- t--------------------------- DATE--------- - REVIEWED BY - - DATE----------- ---------- -------------------- BUILDING PERMIT ISSUED-------'`------------------------------------------------------------------ ----- --------------- DATE Alteralhtions and/or reco - mmendations-------------------- ------_--------------------------------•-•----------------- ------ ----------------------- —-------------------------------- ! ; E� --- `.. -------------- y- ,—.,ww ...rt.-y I) ' ----------------------------- --------------------------------------------------------------------- ------------------------- t .... .,�.e. FINAL INSPECTION BY-------- --- -- ---•-=--v--- ------------ Date-------- � --------------------------------- 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-922M Revised 8-'59 F.P.Co. I _