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' 3 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in in Duplicate) Date I /G -. a e ssued i7W�l , " ', 7-7-'-wr._.�,.w....�..-. �. + ► s�.fwrrw rny�w,r .. -- . Application is hereby made�to'the San'Joaquin'Local Health District for a permit to construct and install the work herein describe/d. This application is made in compliance:ywith County Ordina ce No. 549. 1 ------------ t JOB-ADDRESS ANP,LOCATION----------- s * --------------------- - `. Owner's Name----- �- Phori � � ..�. Address40 ---- ......... Contractor's NameZ:� r ---------•----- ------- Phon �------ Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Mat [] Other ❑ Number of living units: _�_-_ Number of bedrooms __- Number'of baths -_,__ Lot size�__ _ C` -------- ---------------------------------- r — Water Supply: Public system E] Community,system•❑ Private ['Depth to Water Tables`_- ft:` �- Character of soil to a.depth'of,3 feet: Sand ❑, Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe O'Hardpan ❑ Previous Application Made:. Yes ❑ No [Er New Construction: Yes ❑. No ❑ -6FHA/VA:1Yes ❑ No E] r 1 TYPE OF INSTALLATION AND.SPECIFICATIONS: �-.y,(No septic tank or'cesspool permitted if public sewer is available within 200 feet.) o P -; s -} ation--- ----------------.Material-------'-- --- ------------••-------- �Ff" ___Li uid de Ali-------------------- Ce aci No. of tom artments--- Size q p P ty--------------- --- e "#ic a Distance-from nearest well-----------------Distance from found Numabce,from lines nearest well-------------..:.-.Distance of e ch_line ation_________,._-:____-Distance to nearest lot line---------- Number�lof -------------Width of trench--------------------- r Type of.1filter material'_ ______ ____________Depth of filter material---------`__ '_-----Total length--------------------------_____--------- 5eepage P t� Distance,to nearest weEl__ Distant r m uncfatio - Dstanjre to nearest�t l�ir ------- Seepag Number`.of its__ -''_Linin material._ Size: Diameter_ p g --- .. Depthl ___` - *! 1 Cesspool: Distance:from nearest well______________ Distance;fro foundation_:_____r;`-�`_ _ Lining material______----____-___-.______________._. ❑ Size: Diameter , , t_-.1 Depth_ ;� ' `=_ '_1 Liquid Capacity gals. Privy: Distance from nearest well------ __ Distance from nearest building_____________ ___________ ______________ t - , Distance:to nearest lot line_.-- _ -- ' 171 - -.. I - 1- -------------- Remodeling and/or repairing (describe): _: ------ ------------•--- ----------•--------------•----------------•-------------•----------------- ---------------- F _ _ ------------------------------------1- - ----- - ----------------- -------------------------------------"----------------------------------------------------------------------------------------------------------•--------------------------------------------------------- ------ I hereVfafe y that I have p p red,this application and that the work will be done-in accordance with San Joaquin Count ordinancesws, and rules a d egulations .of +he San Joaquin Local Health District. (Signed} L13. •• - --- ------- ---------- a�� r Contract ] E BY•` ,- —a�- = frtle �---,. r -------- -------------- ----------------------------------------------- or (Plot plan, showing size of to}, Iota+ion of system in.re con to weIf$, building ,etc., can be p ed on reverse side). s .-FOR DEPARTMENT USE ONLY �� ! APPLICATION ACCEPTED-BY-------•---- - DATE--------------- -- ------------------------- - REVIEWED BY----'--..------- --------- ------- - ------- ---- ------ BUILDING PERMIT ISSUED-`--------------- --------------------------- ------ DATE----^ -�- -------------- Alterations and/or recommendations:____ �'- ------------------ ------"---- •--•-------------------------------- ------------------ ..--------- -------- ------------------------------ ------------------- ------_ -------_ -------------------------1 -------_-_---- _ ---------::---------i----------- --•--•------------------ -- ----- '._ == a------- °------------------- V` --6-------------------------------------------------------- . 4 i - �r FINAL INSPECTION BY:.;,�- "'' w Date �-7 6--------/ ----------" SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1-57 F-P.CO.