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APPLICATION FOR SANITATION PERMIT. Perl it No _:.4.1,7- }Complete In Duplicate) Date Issued ... Applica+ion is hereby made to the San Joaquin Local Health District fora.permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. p n . JOB ADDRESS AND LOCATION..r4° .. Owner's .... . .......fes....... ...__ ••----...-•-•----•---•---.....---••------------------ 2- •- ._.....�..... Contractor's Name... :.+ .:__.. .�R&11 ....................•............•...........-................... Wallafion will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1...... Number of bedrooms.L..... Number of baths _./..._ Lot size ...1/4_....._4....�-4111.__.-__._ _ Water Supply: Public system ❑ Community system lX Private ❑ Depth to Water Table 1a.'. ft. Character of soil to a depth of 3 feet: Sand C] Gravel ❑ Sandy Loam II Clay.Loam ❑ Clay❑ Adobe❑ Hardpan❑ Previous Applicaflon Made: Yes ❑ No J@ m Now Construction: 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. �istance from foundation..../Q_"._...-:.Material___L�'::._.t7-I+44!S,_-__•_••••._.,,. ® No. of compartments---------Cg-------------Size--• �0---?�- ��...:w..Liquid depth-....6�`...-. ._........Capacity.....f�a_ rhe_ Disposal Field: Distance from nearest well__ '" Distance from foundation.... ....Distance to nearest lot ling........... . Number of lines.............�- Length of each line--------- , of trench-._-P-7.41.__•_-.-----, Type of filter materiaL_.1_3.......�.Ap�.Dopth of filter material..._-!s'_._........Tpfpl length....._.___lo__.°•_____________•-........ Seepage Pit: Distance to nearest well__--------------------Distance from foundation--_-----.-......._..Distance to nearest lot line................. ❑ Number of pits.__................Lining material...._...--•-••__--.....Size: Diameter....._....... ____.•___-.Dep#h....--.........-........-........ Cesspool: Distance from nearest well.................Distance from foundation------__._..........Lining material.........-._..__.............. ..___-_. ❑ Size: Diameter-_,- mm_ ep Liquid Capacity .., - Privy: Distance from nearest well.................................................Distance from nearest ------ . ...... ❑ Distance to nearest lotline......................1—...... .••-•--- .....- ............ Remodelingand/or repairing (describe}:.------•------........--•---...-----..........-.............. .................................._,...............__............................. I - ------ ------t the work will be done in accordance with San Joagain`Co.... W ordinances, State laws, and rules and regulations of the San Joaquin Local Health District: Q (Signed)..- - ........ .................. ............................ ......... ...• -- -.--- and/or Contractor} = =-------•-------------- (Plot plan, showing sae of lot, location of system in relation to walls, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-._.... --.......---•-••----------•---••------ DATE.---- REViEWED'BY..-- QATE__ .... BUILDING PERMIT l55UED. :..:...... --•-- _....... --� ..»:. Alterations and/or recommendations:..........::''` ... ........................ ..-----•-•........ •---• ..........•-•-••-_........--•--......--•--•....................... ... . .............................. ......... I r : ...... .... ./6��i......................M........................... _ FINAL INSPECTION BY:...._.. ----•••• Data-....... ..' : "^* .................. .... SAN JOAQUIN LOCAL HEALTH DISTRICT i30 South American Street 300 Wist,Oak Strad 132 `'f y �• 5yeamera Stnet ��.# '"C"stud. � Stockton, Glifamia Lodi, CoNornia Manteca, Califennia s ,; celoornL 1454"ATWO930 12-54 i