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' FOR OFFICE USE: <br />APPLICATION FOR SANITATION PERMIT /—/f- <br />(Complete In Duplicate) <br />This Permit Expires 1 Year From Date Issued <br />Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br />This application is made in compliance with County Ordinance No. 549. .. <br />JOB ADDRESS AND LOCATeliON... 1-.3,k. . 0.4-.C7 <br />. <br />Owner's Name. CV <br /> Phone <br />~Li Address <br />Contractor's Nam- <br /> Phone <br />Installation will serve: Residence Apartment House 0 Commercial 0 Trailer Court 0 Motel 0 Other 0 <br />Number of living units:/.4... Number of bedrooms firNumber of baths../i. Lot size " <br />Water Supply: Public system urtOmmunity system 0 Private 0 Depth to Water Table ‘62 ft <br />Character of soil to a depth of 3 feet; Sand El Gravel 0 Sjii.pdy Loam 0 Clay Loam ID Clay 0 Adobe ft(Hardpan 0 I <br />Previous Application Made: (If yes, dote I No 5e New Construction: Yes 0 No vi"FHA/VA: Yes 0 No E--- i i <br />TYPE OF INSTALLATION AND SPECIFICATIONS: <br />(No septic tank or cesspool permitted if public sewer is available within 200 feet.) <br />Septi ank.? Distance from nearest well Distance from foundation Material t <br />No. of compartments Size Liquid depth Capacity <br />ee- r <br />Disposal F Distance from nearest well — Distance from foundatjon./b ' Distance to nearest lot line.-) N <br />.2 \--- <br />Number of lines / Length of each line 6-0 0 r Width of trench 4 ' <br />Type of filter material ... .0..c....tr Depth of 'filter mater Total length ial:lir i ' e i <br />Seepage Pit: Distance to nea4st well — Distan <br />Number of pits • / :Lining material <br />c <br />c..k. size: Diameter. 115 't foundation. Id 1 D'gance to nearest lot line .<J —/ <br />Depth <br /> <br />.i <br />Cesspool: Distance from nearest well Distance from foundation ..-.., Lining material - k <br />, size: Diameter .1 Depth Liquid Capecity gals. <br />.1 <br />Privy: Distance from nearest well _Distance from nearest building <br />CI Distance to nearest lot. line.. <br />, I <br />Permit No. I <br />Date Issued / <br />Remodeling and/or repairing (describe)• <br />'1 <br />I <br />I hereby certify that I ha pre <br />Ipared this applçtiop and that the work will be done in accordance with San Joaquin County <br />ordinances, State laws, and es Local Health District. <br />(Signed) '1 <br />By I I (Title) 1 <br />*.. <br />(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). <br />I <br />FOR DEPARTMENT USE ONLY <br />BUILDING PERMIT ISSUED. <br />Alterations a /or. recommendation <br /> fr;efi_ <br />,e—eg <br /> <br />/*7-.4 -.k- 6 <br /> <br />rei-r-s/1 — <br /> <br /> (Owner and/or Contractor) <br />......... <br />APPLICATION ACCEPTED BY re," A(o . DATE <br />DATE <br /> <br />DATE REVIEWED BY <br />FINAL INSPECTION BY: 7.—.7 e, cl (eV-7 ,fa? /4. d Date _ <br />SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> <br />1601 E. Hase1ton Ave. I 300 West Oak Street 124 Sycamore Street <br /> <br />Stockton, California Lodi California Manteca, California <br />E.H. 9 2M 1-67 Vanguard Press <br />,Z- <br /> <br />205 West 9th Street <br />Tracy, California <br />