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r APPLICATION FOR SANITATION PERMIT Permit No. ......5-71.4.-__-. (Complete in Duplicate) Date Issued _X11.G�S�I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th work here n describ d. This application is made in compliance with-Count Qr .finance�� 5 �y,,� / „ l .. ,. - . ,. JOB ADDRESS. AN- OCATION��____ __V___ ,�------------------------ ---- ---- -"�" ---------- Owner's Name__ -----•---------------------------------- ---- -- - ------------------------- ----- - 4 ° 0 k ' ------------------------ on _____ Address----- -• --- y. 7----- P VP 107 Contractor's Name--- -= � ones _` Ph Installation will serve: , Residence 041"Apartment House ❑ Commercial ❑ Trailer Court E] Motel [IOther E]Number of living units:'_-=Number of bedrooms _/_ Number of baths 1___ Lot size..__ �___ -�--------•----------- p . . Water Supply:Public'system'❑ m "Comunity'system'❑""Private De th to Wafer Table&A'ft. i Character of soil'to a Gravel ❑ Sandy Loam ❑!depfh of 3 feet: Sand � lay Loam ❑ Clay ❑ Adobe F] Hardpan ❑ v� Previous Application Made: Yes 0 No tQ�New Construction: Yes No ❑ FHA/VA: Yes ❑ No [13' TYPE OF INSTALLATION AND SPECIFICATIONS: 4 (Na septic tank or'cesspool permitted if public sewer is available within 200-feet.) p -..'r�.• T t --1 Q = M --------------------- ---- Se tic T Distance from nearest well_-_ _ ____ Distance from foundation_ Q 4 N p - ;Size_sW2 -----------Li 'u:d dap#h--- / -- - Capacity-! F ... o,,of,com artments - q p. .. . Disposal F' d. . Distance from nearest well--J.-41 _..._.Distance from foundati n_-a___________-Distance to nearest lot line_-____- Number of lines_._______ _ Length of . to Width of trench_._,�_ '/___________________ Type of filter material_sc__ ..9 ___Depth of filter mate rial_._." 15._--____Total length___Z.4_�________________________ X? -' n Distance tof'nearest well'°"__. ":_-____- _Distance from foundation _______ Dstance to nearest lot line__ _______._____ Seepage Pit:'��` " Number of pits------ -----------------Lining material-----------------`------Size: Diameter---------------=-------Depth------------------------ --------- Cess ool: Distance from nearest well_________________Distance fr f f. Cesspool: -------------�-----.Lining,material--------------------------i- ------ om farundati4on. _ als. _ ❑ Size: Diameter-- - ---------- ----- ---Depth--- --- -- ---------•-Liquid Capacity-------- --- -g Privy: Distance from nearest well- .--��•~ MY-y-�_�- Distance from nearest building____- _ ______"_________ ________ ^Disfanca to nearest lot line_______ ___________ _ i' ' 9 / repairing (describe): 1 _ .. =------------------------ -------------•------------------...—. ----------••---- Remodelin and/or re airin describe ------------------------------------------------------ ., , x y ! hereby certify that I have'prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S, laws, and rules and regulations of the San Joaquin Local Health District. ned --.------ --------------------- (Owner and/or Contract or (Sig ) ---------- ------- -- -- --------- J By.. --•f�-�----.. --- C / �buifdings, {T e) ------------------------------- itl (Plot 'plan, showing size of lot, location of system in.relation t e etc:, can be placed on reverse side). FOR DEPARTMENT USE ONLY;; APPLICATIONACCEPTED BY-- ---•----- ------------ ---- ------------- - ---------------------------------- DATE--- ---------- ---------._... ---------:e---------- BUILIN PERMIT-ISSUED - DATE / REVIEWED BY---------------•- ------------- DATE Alterations and/or.recommendations:-- - .:. Y =-----=---------------------------------------•------ -----•--------------- =~� -------------------------------- --------------------------------- ----------------------------- •---------- -- . is -------------- I F , ' - •-•-------•------• ------ -•------------------------------------------ ----------- ---------=- --'------=------------ ------=•----------- - ------- - . W l; - - - ----------FINAL INSPECTION- - - -- --------------------- SAN ------- ------- -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-4-2M Revisee 1.57 F.P.CO.