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_ C vu 7v AP LIGATION FOR SANITATION PERMIT Permit No. ete in Duplicate) _�'...........:........ �` (Complete 5r-y&/s� Date Issued .._._----------------- Application 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------` _ a .� Owner's Name-----------� ------- ----- APa---------------------------------- -�---�- -------- Phone------------------------- Address--------• •-----jov G �.E"�---- -' - Contractor's Name t----- /�C�/ _ s 'GT S.- ----- ------ Phone -- I Installation will serve: Residences Apartment House ElCommercial E] Trailer Court ElMotel ❑ Other ❑ Number of living uni,fs: 1-___ Number of bedrooms I----- Number of baths Lot size _1;O---- ------------------------- � Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Y__ ft. Character of soil to a depth of 3 feet: Sand C] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobek Hardpan ❑ Previous Application Made: Yes ❑ No�9 New Construction: Yes ❑ No1-1-( FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Se ti nk:�9 Distance from nearest well-----------------Distance from foundation_:----.:_-_--------.Material-------------------.----------------...-_-----,_. r (J No. of compartments-------------_._-.___ ---------------------------------Li uid de th____--_____._____--____Ca acit ----Size Di Po I Field: Distance from nearest well--%5-_---_ Distance from foundation__---__-__-_-Distance to nearest lot e-.7_6Y.---_- Number of lines___________ _________________._Length of,each line_____ Width of trench___r .-_- 9 X _----;;----- P,------------------ Number of filter material-__-_P0.C4---I-Depth of-filter material----.%Y_._-- ----Total length----._._._. --------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot ❑,. , line_------.._-_ Number of pits----------------------Lining materia _____ -------Size: Diameter------------- --------Depth----- - -----------------•.---_-.-,- Cesspool: QN Distance from nearest well-__-___----_-_Distance'from foundation____________----_-.Lining material---._:-_---------------------------- ❑ Size: Diameter--------------------- ------------Dept h------ ------------------------------------ --------Liquid Capacity-------- --------gals. Privy: Disfance from nearest well---------------------- ~____----____________Distance from nearest building._---._--_--------_-----____----_-_---_.. ` ❑ Distance to nearest lot line---.--------------------------------------- Remodeling and/or re airing (describe):---- �_`✓ Z -- �- ------ --- ----------------------------- -----= -- ---- -------- ------ -----------------•-••------------------------------ ? Y e�---- _"` ---- ------------------------------ --------! hereby cert-- that I ha ---minrelatkon ---------: anon and tha-----------•------------------------------------------------------------------------- --------- - --- --------------------- ----- - - y y t the work will be done in accordance with San Joaquin County ordinances, State laws, and . le af he San Joaquin Local Health District. ------ - �, =_ caner anon Contractor) (Signed) - ---------- BY=-------------------------------------- � f'G=�--- (Plot plan, showing size of lot, Iota relation to wells, building c., can be placed on reverse side). i FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED B ------ -------------------------------------- DATE - {� ----- REVIEWEDBY--- - ------------------------ �___`_----------------- � --- ------------------------------------------ DATE-- ----------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------=------------------------------------ DATE--------&—------------------------------ Alterations and/or recommendations---------=----------------------------------------------------------------------------------------------------------------------------------•-------..._..----•- ---------- t _ .:__ ,4 .�-.r.r� � u - " l-T----------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ L9 FINAL INSPECTION BY:--------Jp-r- .... Date----- t---_; -k--�s�----------- ------------------------- 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-9-2M . Revised 1.57 F.P.CO.