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i� � APPLICATION FOR SANITATION PERMIT Permit No: ._-/-Lt-- (Complete in Duplicate) Date Issued --_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. d This application is made.in compliance with County Ordinance No. 549. !7s r7o--z� JOB ADDRESS AND LOCATION_-------- 1-76.7 ------- ------------- ------•- Owner's Name r �";' � ! --------------------------- --- Phone-hio-01Ma�_- . Address --- - ----------------- ----- ---- Contractor's Name--- Z Installation will serve: Residence Apartment House ❑ Commercial D Trailer Court n ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms _ I N-. Number of baths --- _-_ Lot size -- - --� Water Supply: Public system _--_ PP Y� ��ommunity system ❑ Private Depth to Water Table J--f ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay El Adobe Hardpan E]Previous Application Made: Yes ❑{ No L l'—New Construction: Yes ❑ No WHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well�Q f-____Distance from m f u�dation-_ :_ t fy No. of compartments-_ i- 10 -----:.Mate ' 1-------- -------- ---------- 6K -------------" Size- �___>( Liquid depth.e f� -- ---F ----Capacity_ LlF Disposal Field: Distance from neares# wail �/ << ,� d a�--Q-.___"-.Dis ante tom oundation___ ,�g aQ-__""-Distance to nearest lot line----_1P_______ Number of lines�_-_-_ � ; -- ------------Length of each line--_- it Type of filter material_ _ "� or Width of trent --_ -�--------- ' Depth of filter material-------_-1 -Total length.. °I-•-"---- r Seepage Pit: Distance to neari #-'well_- _ g 15 f afro foundation'--- __ pin n" maD#eraal ` 2-Y �'�-r Distance to Weare o to _ Number of pits---- - -- -- ------- -------- { � s fx Size: Diameter----J aC- __-.Dep r Cesspool: Distance from nearest well-"--.---_____:!�tDrstanee from foundation----------------- - Lining material----- ti ❑ Size: Diamete.r------t------ `'`',`7 De th-r�.... I ..�.� = p - -Liquid uid Ca acs ti Priv t 1 1 ~ ' p I q P �tY' �, ---•---gals. Y Distance from nearest well-_______________ 1i .,.Distance'from nearest building---- f - K i ------------"----_----------------:".i ❑ Distance to nearest lot line_______" __"--- _ �► ----------------------- g / rpa ri (des ibe):---F ---n,;7;_ c-� � e e m and/or re yr + f I •------- ' -"1 I hereby certify that I have prepared this application and that the work will be do in accordance with San Joaquin County ordinances, State laws„and rules an .regulations,of the Safi`.-j�oa.,,Uin Local th 'st ict.Si Wed I � t- # - Id {` ,,. Contractor -- -- --- -- - - ---------------- -- Title) --------- location(Plot plan, showing size'of`lot, of s stervisi�n relation fo' wells b dings, et an be placed on reverse side-- - - --------- ----------- - I FOR DEPARTME USE ONLY ! APPLICATION ACCEPTED.BY_ - ..---I - --- - --------------- ---- DATE -- -- l ----------- ” , ---- --- ----. DATE---- -------- il UILDING PERMIT fSSUED---•---------- ---------------- - � -..-------- ------••-------...----------- i -- -----------------•- - --------------- DATE.----- ------=------------- Alterations and/or recommendations:__"_-_-_,___.____._--- ----"--`-----" - -------------•------------- 0 ------------•--------•- ---------------------- - I: - --••------•--------------- --------------------------------------------------------------------------------------------------------- ------------------------•--- ------ FINAL INSPECTION BY:_---- .-__-- -- Date-_-- -l-1--- SAN JOA UIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street F132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ' E5-9-2M Revised 1-57 F,P,CO. �'