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s --}} APPLICATION FOR SANITATION PERMIT Permit No. _--1<-3:�.!_.--__ J 1 (Complete in Duplicated Date Issued --- pplica}ion 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 complia with County Or ' ante No 544. o , Z y�` leek-" ADDRESS AdND _d ;7-4--. -- - ----�--------------------------------------- ------- ----------" "'"- Name a e --- --- ------------------ Phone-!---- Owner's 4�3.fi T Address rQ-' r ,..� S"1 30 3 rw ------------ ---------------- --- -- - --------•• -- -- Contractor's Name ------ Phone.---------� Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other [ ^ Number of living units: Number of bedrooms A Number of baths 9ily__ Lot size Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table..!2 f. •f— Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam ElCla Loam E] Clay E] Adobe�arclpan ❑ Previous Application Made: Yes �No El New Construction: Yes E-] No ""� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Distance from nearest well-----------------Distance from foundation_-----------------Material_--___--____._-____----.-.--__----..-------.--. No. of compartments------------- Size--------------------------------Liquid depth--------- ----------------Capacity----------------------- oral ' Id: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line.-_---------_._.. Number of lines-----------------------------------Length of each line-------------------------!-----Width of trench----------------------------------- Type of filter material-------------- -------Depth of filter material------------------.----Total length---_-_-__-__-_-_----_____-____--__-. it Distance to nearest well-._Nrn_ ''---Distance-drom foundation___�f�__-.-_.D' tante to nearest lot line-- _ Number of pits--- ------------Lining material r- �"--- 7 ��-------Deptn--�c ,f .�------- -----...Size: Qiameter-.-- --- Q , Cesspool: Distance from nearest well------------------bistance from foundation--------------:-.--.Lining material--..--_---__-_______-_____----___--- 1� ❑ Size: Diameter-------- ---- ------------------------Depth-----------=---------------- -- '- ------- ------Liquid Capacity-. -----•------------------gals. �► Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----....------.-------__------.----_-----. ❑ Distance to nearest lot lire----------------------------------------------- -----------•----------- .---------------••-------- Remodeling and/or repairingIdescr'sbe):--------------------- ---_-----------------------------------------------------------------------------------------•- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- -- ------------•--------------Ifiss --------•------------------------------------------.--------•---------------------------------------------------------------------------- I hereby r ify th I have preparplicatioAatthe the work will be done in accordance with San Joaquin County ordinances, Sta a , and qJe and reof the Local Health District. (Signed)------------_--• --- '---- ------------------------------------------ --- ---- - -------_----------------------- --Fedon - arr Contractor) By:-------------------------------------------------------------------- --------- ------------- - ------(Title)---- - `------ ------- ---------- (Plot plan, showing size of lot, location of system in relatbuildi s, etc., can be plaverse side). FOR D PARTMENT USE ONLY Q APPLICATION ACCEPTED BY------------ ---- ------------ ----- ----------------------------------------------------------- DATE--------- .l� REVIEWEDBY-------------------------------- --- -------- ------------------------ --------- ------ ------------------- ----------------- DATE---------------------------------------------------•-- ---- BUILDINGPERMIT ISSUED----------------- ----------------------------------------------------------------------------------- DATE------ -------•----------- ---- Alterationsand/or recommendations-------------------------------------- -- -------------------------------------------------------------------------------••-------------------•-•-------- -------------------•---------------------------------------------------------- --------------- --------------------------------------------------------- ---------------------------------------------------•-------------------------- ---------------------------1------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------- ---------- -------------- --------------------------------- ---•-----------•----- -•--------- -------------- I ---------------------------------------- ---------------- -----------•-------------------------------------------------------------------------------------------------------+------------------------------------------------ FINAL INSPECTION BY: - Date - 1. - -------------------------- 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 E5-9-2M 145445 ATWOOO 12-54