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rill—,Permit No. 2- APPLICATION FOR SANITATION PERMIT ry, (Complete in Duplicate) Date Issued ---- N Application is herebymade 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 OrclinaNo. 549. ----------- ------------- ---------------------- JOB ADDRESS AND LO ATION-- ------ MA_(o----------- vf. %_ _ Phone-- e --- ----------------------I-------------- ---------------------------------- ....... Owner's Name---•---- I------------ A ................ ------------------------------------------------------ -------------------------------------------------------- ------------- Address---_------------------ Phone_____m�-------------------------- Contractor's Name------------ -- ------ ---------- ----------------------------------------------------------- I I ", - . ❑ Installation will serve: Residence WL-Apartment House El Commercial E] Tinier Court [] Motel [j. Other 5L. Number of b -1-11,,"LOt size ------k_2�_(A----)I----2.Ci,-1-------------------- Number of living units: --- Number of bedrooms -,-, , baths Water Supply: Public syste ommurfity system 01 Private —Depth t6 Water Tables-7b ft. A -4 1 Adobe Hardpan E] Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam E] Clay Loam [I Clay [3 Adob Cha El I I Previous Application Made: Yes El No F&_ New Constr I uction- Yes &_ No ED 'FHA/VA-. Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: At — (No septic tank-or`cesspool permitted if public sewer is available within 200 feet.) I ci Distance nearest well 3nce from __--___Distance from,fojdation city..-, ---:_'_Liquid cle — - "I-- -_ menfs----21--------------_Size__3_ V--------- Capa Septic Tank: Ipth----- No. of compart I rn foundation-__ 1.1n--------Distance to nearest lipt lige--s-----------Disposal Field:} Distance from i near 8t,well ---Distance fro ine------96r---- Width of trench ------ _e material___ s---- Length of each I it-------- Number of line Depth of filter material------M-------------Total length__It Type of filter material--- ..... I Distance from foundation--------------------Distance to nearest lot line___-___.____---- ❑Seepage Pit, DistAde,t6 nearest well------------- -------- xj Njnnb,rl of pits---------------------Lining material ------------------------Depth---------_-_----------------- Size: Diameter 1 # Uj i, ------------------------------------- ,L D isId n ce f roml nearest a rest we I I-----------------Distance from foundation___________._ Lining material L Cesspool -------------------Liquid Capacity----------------------------6als. 17-1 Size: bia�meter-------------------------1----------Depth--------------------- ----------- 11, .1 1 Distance from nearest building------------------------------------- Distancp Irominearest well_____------------------------ Privy: - i --------------------------------------------------------------- Distance to-n,earest lot line------ ---------------------------------------------------------------- Remodeling and ------------------------------------------------------------------------------------------------ I , --------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------I---------------I-------------------- ------ - i � ------------------------------------------------------------I------------ --------------------- -------- ----I----------------------------------- --------- --------------------- le - ! ------------------------------- ---------------------------------- --------------------------------------------------------------------------------------------------------------------------------- ------- -accordah8e with San Joaquin County I hereby certify tha I hav6 prepared this application'al"t'id'that the work'-will-6—edo"ne in ordinances, e"laws nd ru6ra-rid regul tions of the San Joaquin Local Health District. 4k I - tw] ---------------I---------------�_(Owner and/or Contractor] c ---------------------I---------------------------- --------------- - ----------___1------ - -------- (Signed)----4- ------ ------ yy I k ----------------- (TRIG)----------------:- -------------------------------------------- B ------------------------ ------------------- ---------------------------------------------------------------- si ' of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). (Plot plan. showing size FOR DEPARTMENT USE ONLY r --------------------------- DATE---------------- ------- APPLICATION ACCEPTED BY-- ------------- ------------- --- T AT E7t 0- -- - �---------------------------------- BUILDING",PERMIT DATE-------tREViEWW'SY------------------------- ---------------- Te ...CA " ----------------------- IDATE--- ---------------------------------------------�-------- ISSUED--------------------- ------------ -------------------------i------ ---------------- Alterations and/or recommendations----------------------------- ---------------------------It------------------------------- ------- ----------------- -- - --- ----2......... -—--------------- 04-u ;;;6---Cf --- -- ---- ---- -- --------- -------- ----- -------I-- ------------------------------------------ --------------------------------------------------------- ------------------------------------------I----------------------------------------------------------------------------- -------------a...----. ------------------- --- ----- -------------------w---------------------------- ------------------------:-------------------------------------------------- ----------- ------------------------- . I 3 . ........................., FINAL INSPECTION BY:__� ------------------ ------------- - ------------------- Date... -0------- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT C_0 16j7_ � j 300 West Oak Street 132 Sycamore Street 814 North "C"'.Street 130 South American Streof Tra`c�Ciaifornia Stockton. California Lodi, California Manteca, California ES-9-2M Revised 1.57 F.PrCo.