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F eb, OR SANITATION PERMIT Permit No. ....................... j S ' (Complete in Duplicate) This Permit Expires I YeaiJrom Date Issued 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 L N-,,o-- Owner's Name---------- -- ------------------ ------ - ----------------------------- ------ Phone------------------------------------ Address---------------------------------- .........---- -- - ----- - ContractorsName----------------- ---- --- -- - ----------------- - - --------------------------------------------------------- Phone------------------------------- Installation will serve: Residence g?"Apartmenf�House [-] Commercial E] Trailer Court E] Motel 0 Other L] Number of living units: __/--- Number:'o'f' bedrooms S- Number of baths J---- Lot size -_________________ Water Supply: Public system El Community system El Private k**Dpth to Water Table -1yo-6. Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam Ej Clay Loam E] Clay 0 Adobe &--Hardpan Previous Application Made: Yes [] No ( New Construction: Yes W2"OON o E] FHA/VA: Yes U;ol**No Ej TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well tra-----Distance from foundation--Vp----------maf2iaI_____e_ No, of compartment's------- ------------Size_%f__6__X-f-e----Liquid depth_-- ---------------Capacity--- -------- /. V 24�9_ Disposal.. ielcl: Distance from neafes; Distance from foundation---4__7_0"__Distance to nearest lot line--4 Number of lines----- I----- Length of e _a--------- ach line----- 1 Width of ---------------- f Type of filter material--,/ Depth of filter material--- .__..___.Total length-----A0740---------------------- - I /% I _de Seepdae. Pit: Distance to nearest wefl1,2.,oV_ &4--------Distance fcQm foundation---�1_jpe----DistarLcp to nearest lot line__U:�---------- Ae 4r Number of pits------1Z------"--Lining mate Size: Dia nete',___Jd_`_I------Depth__AX. .,41'/AA,, Cesspool: Distance from nearest welA-----------Distance from'f6undation--------------------Lining material__________._______.____.______._...-. F❑-1 Diameter----- --------- Size: Da. ----_----------------------- Depth--------------------------------- -----------<_Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.__._._.__._________._________._...___- 1 F1 Distance to nearest lot lire------------------------------------------------------------ -------- _7-------------------------------------- -- --------- Remodeling and/or repairing (describe):----:------11'- i -------------------- 4 - ____ ------------------------------------------------------ ------:---------------------------------------------------------------------------------------------------------- - -------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------ -- ------------------------------------------------------------------------------------------------------------------------------b-------------------------------------- ------------- I hereby certify that Ithave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, anj rules and regulations of the San Joaquin Local Health District. (Signed)- ---------------------------------------------------------(Chmer-midoU Contractor) - -- - - ----- --------- By:--_-------------- --------------------------- All ------0o--------------------(Tifle)--A Xi1Xe4,-` ---------------- ----------- (Plot plan, showing size of lot,-location 6f m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 7_ APPLICATION ACCEPTED BY------ --- ----f--R =----------------------------- ---------------------------------------- DATE------7-1--1_6c------------------- REVIEWEDBY------------------------------------- -----------------------------------------------------------------------------------1- DATE------ ------------------------------------------------ BUILDING PERMIT ISSUED----------------------------------------------------------------------------:------------------------ DATE------------------------------------------------------------ Alterations and/or recommendaf ions------------------------------------------------------ ------------------------------------------------------------------------------------------------------ ----------- )�------------------------- -------------- ------------------------------f%) --------- -----------�?i-t;7-7D--------------------- ------------------------------------------------------------------------------------- ---------- --- - - - ------------------- 3 HS ----- --------- -------------------------------------- --------------- ---- -------- ----------------- ------ --- --- -- ------------------------------------------------------------------------------ ------------------------------- --------------------- ---------------- ----------- .......... . --- ------------ -- - ------ -- - --- -- ----------- -- ----------- ------------------- - - ------------- --------------------------------- FINAL INSPECTION Date--... --------------------------------------------------------------- SAN JOAQUIN.LOCAL HEALTH DISTRICT 130 South American Stre'e't. zt 300 W4;sf�Ciak'Sfri 1� 132 Sycamore Sfreat 814 North "C" Street ' California '% "I "I 'Man , California,, Tracy, California Stockton, California Lodi, Manteca, Califiir ES-9-2M Revised 6-'59 F.P.Co.