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APPLICATION FOR SANITATION PERMIT Permit No, -1.2_.7- •.. " (Complete in Duplicate) This permit Ex fres 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install th This application is made in compliance with County Ordinance No. 549. e work herein described. JOB ADDRESS AND LOCATION'-_-.-•"____ - • ----------"---_--_-•--."-------_---- -- ---/-_--••-• /--2--_---- - .Owner s Name ----------- Address---- ------------------------- '`='--_- Address -------------------•---- --------•--- ----- ---- ----- ------------------------ ------------- - Phone- ----- Contractor's Name ----•-----•- -` �-- - _____-_ ------------------•-----• --•-- --•----• ---• •- Installation will serve: Residence �/ • �-----•-------------------- --------- •--- Phone-- ,® Apartment House ❑ Commercial f Number of living units: -_ -_ Number of bedrooms ,- ❑ Trailer Court ❑ Motel ❑ Other ❑ Wafer Supply: Number of baths ---e--- Lot size -------(5---?- .---- � PP Y� Public system � Community system ❑ Private Character of soil to a depth of 3 feet: Sand ❑ Depth to Water Table - --" ft. ❑ Gravel ❑ Sandy Loam [:] Clay Loam 7 Clay ❑ Adobe❑ Hardpan Previous Application Made: Yes [] S❑PECIFI®TIONS.NewConstruction: Yes ❑ No [R FNA/VA: Yes El TYPE OF INSTALLATION AND (No sepfic.fank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: p Distance from nearest well-.- --- _ ® No. of compartments---- Distance from foundation----f,l Material---- ______" t -- ---`�=-----Size----�-.,�1' i - - + Disposal Field: Di"stance from nearest well-_------ X"^` Liquid depth__.--_ -_ Ca acit ____ o a -..-.Distance from foundation-----7r,I`___ p Y Zr Number of lines---------------/- --------Length of each line- a--�--- ' Distance to nearest lot line-----/. Type of filter material---- Cc. pepth of filter material-- /- Width of trench- "----;-__-y / Seepage Pit: �' Distance to nearest well- "-- - .�' Total length-------------�.,�- i Distance rom foundation---___:2"-�` D \ Q Number of pits---- -------_.Lining material"/ istance to nearest lot line--._ ----------- - -a _ �`r� �- - --... Diameter---��_� _Depth _-----___ Cesspool: Distance from nearest well--------------.__Distance from foundation._..- -.------------ yr p ❑ Size: Diameter--------------------- - Lining material.------.----"----- --------------Depth------------------------------------------- ------- --ga Privy: ;..:-> Distance from nearest well------------------ - -----•-Liquid Capacity-_-_-"______"--_-___---- - - - ------------------- Distance from nearest buildin gals. 1-1 Distance to nearest lot line_ Remodeling and/or repairing (describe)--------------- -- ---------- --•-•-------------------------------------- . I hereby certify that I have prepared this application and fhat the work will be done -- actor 1 ordinances, fe laws, and rules an regulations of the San Joaquin Local Healfh District. i dance with San Joaquin County (Signed}_. ,. r> ------------- BY: -----•------•--•---------•----- - ------------------------ -------------------------------- ---------------------- {Title)- ----------------Owner and/or Contracto . ot plan, showing siie.af„lot location of sysfem in relation o„wells, buildings; etch°vain'be placed on reverse side). FOEPARTMEW USE ONLY f APPLICATION ACCEPTED BY". _-Ir* -= ___._"_ REVIEWED BY"__._._•. g /1•� ------ DATi -- ------- ------------------------------------•------•--.- - -------------------------------------------------------- o' f BUILDING PE�R�IvfI�'��I'SSUE r-"=. .. - ----- -- DATE�- Q ' i - t Alterations and/on t�atom ndafions --- .`;..1-_. to ------ DA-T-0 ------ ---•------ /r _= ----------------•-----•------------- I- ...-x� .�"::Uig-.x• __"-------- -- ----- h1-M`1 FINAL INSPECTION BY: . ----------------------------- - Date ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streof Stockton, California 132 Sycamore Street Lodi, 814 North "C" Street i, California Manteca, California Tracy, California ES-9-2M � Revised 8-'59 F.P.Co.