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APPLICATION FOR SANITATION PERMIT Permit No. 6 (Complete in Duplicate] ' 7 Date Issued ____;,/��.•___ Application is hereby made 'to the San Joaquin Local Health District for a�permit to construct and install the work herein described. T is.applicatiori,.is.made.-in compliance with ounty Ordinance No. 549 'r-n.J d-L�E rr u!A- ► JOB ADDRESS AND TION- - � � �`,�Ct�t� E ll. 44i 44 ------ Owners - „ Name----- -- --- - - E .. Address-------- . ys ------------•---------- 1 Contractor's Name--- ` --- --- ---------•--- Phone_---•-------------------- --------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer6 Court ❑ Motel ❑ Other ❑ Number of living units: ,-4__ Number of bedrooms ;:V Numbe'r of baths: � 'Lot siz ______________._____ Water Supply:"Public,system ommuriity'system-❑'"Private'❑"' Depth to dater Table /_4'@ ft," Character of soil to a depth of 3'feet:i .Sand ❑ , Grave I#❑., Sandy Loam ❑ Clay Loam ❑, Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes {] No New Construction: Yes lo.:❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:_ (No septic tank or'cesspool permitted.if public sewer is available "Within.200 feet.) . �... _ is ._..�.....�,. ,. �� . p `# isf efrom-foundation-- ____.____. at ria___ ______________ No. of com artments___ Se tic Tank: Distance 'from nearest wgll__ _ �R41�D e _J ___Liquid depth__h _ ____--_-__Capacity___ _h f isposal Reld: Distance from nearest weil_Ae-A&Sistance-from foundation--- ----------Distance to nearest lot line--d-.--.-•-- Number of lines--------------- ength"of each line--:__4'T ------Width' of trench.--__rzfi_��____r_ e th of filter materia!_ e-----_ Total length_______ Type of filter:materialf. ------ P f�tI Seepage Pit: Distance to nearest welL' 1_Dsstanee.from fou ation___ :. _.Distance to nearest lot line._______.._. __Linin material _ _ Number of pits._____1a_.__ g k ..Size: Diameter�J-�---..-_..Depth_____ _ __ Cesspool: Distance from nearest well________________Distance from foundation____._______--------Lining material--------------------------------------- Si2e:Size: Diameter---- ------- ---------- =Depth_------------=-`---------------------------- -----Liquid Capacity-----------------------------gals. M. Privy: Distance from nearest well: _-.--"_-__. __:_',__--_--`_'-_`_.__- -----_Distance from nearest building_________-_____________________________ ❑ .. Distance to nearest lot line-----= -------- ------- -------------------- - _:: ------------------------ - Remodelingfante�d,,/o�j re a ng (d scrib -• - --- .-----=-- -------------------------------- 4 :.- _ _ ----------------------- ------------------ - ------------------------------------- ---- 4 E F ___ _ _ ____________________ _ ______ _________a__-______________________-_-________a______-_____.____.___--_________________.____-._________.________________._____________-__-________-.----_.__-__..________.___- ______ r _I hereby certify that I'have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed]------------- --- - - - --�� .-- (� Contractors - - -----------i----------------- ------- By-------------------------------------- -- R--- --- - - - --- - --- (Title)-_•-Cyt'�--��de). -------------- 1 (Plot plan, showing size of lot cation of system in relation to wells, buildings, etc., can be placed on rev i - - FOR DEPARTMENT USE ONLY 1 I APPLICATIONACCEPTED BY----- ---=------------ ----- -- ---------------------------------------------------------------- DATE------- ---------- ---------- ----=- ---- REVIEWEDBY------------------------ ---- -------------`-- -----------------------•--• DATE------ ------57_•---------------------------------------- BUILDINGPERMIT ISSUED--------------------------------- ------------------------ ----------------------------------- DATE------------ ------------------------------ All ------------ ----AI erations and/or recommendations:--------------- ---- ---- - ---- -------------------------------------------------------- -------------------- - ----- ---- ---- ----- --- - ---- ---------- �- -----_ ° _._.��__ ------ ----- -•---------------------------- -------- - ---------------- --•-----------------------------------:---------- ------------------- _n -._----- FINAL INSPECTION BY ..--- Y . - = = -_n _ Date---- �_=y=�-� ------------------- == i : SAN JOAQUIN LOCAL HEALTH DISTRICT 4 130 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 , Revised 7.57 F-P.CO. C/ '