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n Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 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 LOCATION.__-- - n � '�`� ---; --------------------- Pho e �P �� ---- Owner's Name---------------`- 4 -- ----------5 -------- Address------ � --- -----------=-------------------- _ --------------- Phons..._.----- f` � �� Contractor's Name_. . � --- - - S-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: __.i[___ Number of bedrooms --Z- of baths __I..__ Lot size . - Water Supply: Public system f Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes [I No New Construction: Yes ❑ No p--FHA/VA: Yes E] No 'TYPE Of; INSTALLATION AND SPECIFICATIONS: e4dr �Sgt ,!tank or'cesspool permitted if public sewer is available within 240 f f�.l� �� (� Distance from nearest well_"��=__Distance from foundation_------------------MatenaL_.....'-..._.___'------_-{----------------;:-�-No. of compartments------ -= ----------Size------------------------ Liquid de th------------------------ Capacity. .cr-J Distance from foundaon-- -------------Distance to nearest lot line...: Distance fram nearer well._l4`�L4Rf - __ Width of trench �'Len th of each line.. 4 Number of lines....__. __._ _-____-- g - "- �-"- "Type of filter material. _A-C,- -.Depth of filter material..----� _ _...._Total length.................._.- �-----0 1 = �+ �4 l ..___.D"sstance to nearest I ii �..__ .. Seepage Pit: Distance to nearest well__ . W- _ Distance om f undation... ._ Number of pits._.._-------------- Lining material--t\- -�,',- ---- Size: Diameter_-- Depth_-- --------------- Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material------------------------------------ �. ❑ ---------De Liquid Capacity------------------------- --g th--------------------------------------------------- Size: Diameter------------------------- -- p 6� Privy: Distance from nearest well--------------------------------------------- --_Distance from nearest building------------------------------------------ G ❑ --------------r- Distance to nearest lotline----------------------------------------------- - ---------- ---------- ---- -------------------------- - Remodeling anci/or repairing (clescr-iibe):___ - -------------------- -P-J-- ----7-e ;U-p- --LOO-------------------------------------------4--------------------------- ----------------------------------------------------------------------- ------------- ------- --------- ---------------------------------------------------------------------I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinance , ate laws, a d rules �ncl reg 'ons of t in Lac Ith Distri t. . . ` EL.. V Contractor] (Signed)--- - By:--------------------------- ----- �' ----------------{Title)---------- -------- -------- ----------------- ---------------- (Plot plan, showing size of lot, location of system i r tion to wells, buil gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY A APPLICATION ACCEPTED BY ----------- ------------------------------ ---------------------- DATE --- REVIEWED BY----- -------=------------------------------- - - --- ----------- -------- ------------- -------- ------------------ DATE---------L -------------------------- BUILDINGPERMIT ISSUED------------------------ --------- ------------ ------------------------------------------------- Alterations and/or recommendations:_----------------------- ----- _ _ J 7 �. f.f8 ✓f'?/-�L�"?� �tL/1-:!„ ............. '----i--_-__.... _._.`__..1,."...._.-_.._"_...-.-.--------------------------....-_-...____..a.._. ---------------- -- L6 �R,� / i✓•Pic :�z� Y U t.Fz1 ----------------------------- -----------------•------------------------------------------ 1� ` ; FINAL INSPECTION BY:__!.. __.__•�:W .-_ Z_ �� Date-------J�"-------1"-' /'--'�--- ----------- ------------- ---------�. SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y+ ES-4-2M Revised )-57 F.P.CO.