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APPLICATION FOR SANITATION PERMIT �� a Permit Na. ..._.!_. _.y4_. �— (Complete in Duplicate) ' g -.3 .. This Permit Expires I Year From Date Issued Date Issued _____________________ 'v 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 inrcompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION �� -- �� dpi(--2-2-0.-�a ' --------- Owner's Name------- - -•---- --- ----�h ! ----- Phone- ----------------------•-------•--- } Address /S ------------------------ -------•---•--------•-------------------------- ---• •- --------------- Contractor's Name-------------------------------17- � Phone '.- _-•-- ------ Installation will serve: Residence Apartment House Commercial ❑ Traile Court [:] Motel ❑ Other E] ; Number of living units: __ _ Number of bedrooms _-c3__ Number of baths ----____ Lot size _-- ------/yQ------___--___________-- Water Supply: Public system [�'ommunity'system E] Private ❑ Depth to Water Table i�?ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [ lay [] Adobe ❑ Hardpan Ej r Previous Application Made: Yes ❑f No L"I New Construction: Yes R--- o ❑ FHA/VA: Yes M/' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted [ft-Pybl�ic�sewer is available within 200 feet.) Septic Tank: Distance from nearest well 1_YM-4 __Distance from u l p -- ------- � dot•on---�Q------._.Material---- ------------ -------------------------- No. ----------------------- � r [ No. of compartments--------�---________Size__S ,� !� )_6 Liquid depth____ -F3-.._____Capacity_.��r. 1 - i r Disposal Field: Distance from nearest wel1>-�?L-e._Distance from foundation__.�AQ____ Distance to nearest lot line_ . ©� Number of lines __________ _ ___ _ Length of each lineg6(-Z/614�/ -Vi.-Width of trench___._-- _ ________________ ` Type of filter mterial_ ,_- Depth of filter material___ $ �_____._Tatal length _�-- -'_________-______. N See Pit: Distance to nearest well----------------------Distance from foundation----------.---------Distance to nearest lot line._____.________.- Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth-------------------------------- Cesspool: Distance from nearest well--------_--------Distance from foundation--------------.-----Lining material__._____________________________.._. Size: Diameter- th--------------------------------- ❑ -----------------------------------De I p - - ---- - - -- Liquid Capacity----------------------------gals. Privy: Distance from nearest well---_____------------------__---------------------Distance from nearest building--------------._______________---------- ❑ Distance to nearest lot line- -------"------------------------------------------------------------ ----------- Remodelingand/or repairing (describe):---------------------------------------------------------------------------------------•------------•-------------------•------•---------------•-----•-- t l I herebilafy that I have prework will this application and that the wowill be done in accordance with San Joaquin County ordinances, t to ws, and r es and r ulations of the San Joaquin Local Health District. (Signed) r (Owner and/or Contractor) j BY -----(Title) (Plot plan, showing size of lot, location of system in relation to we , buildings, etc., can be placed on reverse side). I' I FOR DEPARTMENT USE ONLY k I APPLICATION ACCEPTED BY------ - ----- ---------------------------------------- DATE--------Sr - =3 41P cr .I REVIEWEDBY------------------------•-------------------- - -------------------------------------------- ---------------- DATE BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------•---------------------- DATE-------------------------- I Alterations and/or recommendations---------------- -- ------------------------------------------------•--•----•---------------------------•--------•-•---•-----------•--------------------------- a --- • ----------------------•---- ---------------------------------------------- •--------------•--------------- ---"----•---- --------------------------------------------------------------------------------------•-------•--------------------------------------------------------------- ------------------------ ------ ------ ---" '---------------------------------------------------------- --------- --------------------------------------------------------------- ------------------------------ R FINAL INSPECTION BY:Z1. --- �11W -- Date-------------- -rSAN JOAQLLOCAL 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 6-59 F.P.Co,