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.� =•�� Permit No. .__'�I.`F�4=---...: APPLICATION FOR SANITATION PERMIT` + (Complete in Duplicate) ,5 p bate Issued _��_�----------- a Application is hereby made to the San,Joaquin Local Health District for a p f to can ruts and install the work herein described. This application is made in complian A County Ordinance No. 549. JOB ADDRESS AND LOCA ION - - 9 _4---------- 7- Owner's Name-----___-- -_ PhoneT - �- z9 � t4 ex Q.�ti. - -------------------•--•------•----••-•---••---•--••-------------------- Address-------------------------- --- __.____ _ ___ _________________ P Contractor's Name---- ---- Q�14 — _. _.._. Phone.- ----- �`-- _ Installation will serve: Residence M--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El ----- Number of living units. _1--- Number of bedrooms _' (Number of baths 4---_ Lot --` - 1 -`- ---.. Water Supply: Public'systemCornmun`ity system ElPrivate ❑ Depth to Wafer Table: t. x' Character of soil to a.depth of.3 feet:' Sand E] Gravel E] Sandy Loam ElClay Loam [I Clay C] Adobe = rdpan ❑ Previous Application Made: Yes E3 No D' New Construction: Yes ❑ "No ❑m FHA/VA: Yes ❑' "No ❑ �:_ ?/� TYPE OF INSTALLATION AND SPECIFICATIONS: �-'� No septic tank or,cesspool permitted if public sewer is available within 240 feet.) l e is Tank: Distance from nearest well_________________Distance from foundation____.___.-_-_______Material____.___--_____- _._______________-______.__--_.-� t p Liquid depth- -----_Capacity_ No. of compartments --.---I Size--------r---------- q g = n t - c. posa�l, field: Distance from nearest well---------------'r Distance.from foundation--------------------Distance to nearest lot line_____:_--_._____- Number of lines-----------------------------=-----Length of each line--------- Width of trench --------------------- Type of filter material--------------------- ---Depth of filter material length----.------•---_-_-- . -�. .. . .t-`' f z �_ Distance to nearest lot line_---5-_______ See a e Pit: Distance to nearest well__ �'?_Cf�=--Distanc�„�rom foundation__�_�=_____-_. Number of pits------ '--------- R __Lining material_: _W:i7 -... Size: Diameter-__, .---a----.Depth_ -_=�-------------------- Cesspool: Distance from nearest`well__N^_,_______--Distance from foundation-------_......______Lining material-------------------------------------- m ❑ S • Depth Liquid Capacity---------------------------gals. Size3 Diaeter----=------------------------ f Privy: Distance from nearest well_____------- _______Distance from nearest building__________________________________________ v ❑ Distance to nearest lot line----.-=_.-t _ - ----------------•--------------•------ N i Remodeling and repairing (describe):------- - =' ' :. = _ __.. :..- �. �..., ------------------------------- --------------------_____________________ FY�------r _ pl _____________________------- It. ___»..___________._______________.____ :___________________._________________._____.______.. _____________________________3-____________.--_________--_______________________--_____--_____________.-____________-»____._____-_______._.________________________.______________-.____...____ I hereby erti that-I have epared this application and that the work will be done in accordance with San Joaquin County ordinances, St to I s, an rules nd regulations of the San ' oagyin Local Health District., t 1- ---------- } 7 ntractor) ( g Si ned ) ----------------------------------- ''i ---- ----------- ------------------------(Titl ---- �� _ -- -------------------- By:------------------- ---------- ----- ---- - - (Plot plan, showing size of lot,"locat}on of system i relation to wells, b dings, etc., can be ace on reverse side). FOR DEPARTMENT USE ONLY fi APPLICATION ACCEPTED BY------ ------��- -- -- ------ ------------------------------------------------ DATE -. ------- ---- --- -- - - --------------- -----------------=------ ---------------- DATE----------- ---•-•----------------------•-------------- REVl1=WED BY-----�-------------------F------�- - - - BUILDING PERMIT ISSUED-----------'--- - DATE J Alterations and/or recommendations:---= -- - ----------------------•----------------.-------------•-------------•---------------- _------ = --------------- ---------- _ ----------------------------- �. /--------- pf G - fG ---------•-------- - ----- � L - � r r' .----.---- �� ------------- ----- ------- _ ------ FINAL INSPECTION BY - Date--.- ------------------ SAN, JOAQUIN LOCAL HEALTH DISTRICT 130 South American-Street 300 Wast Oak Street 132 5yeamors Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5--9-2M • Revisea 1-57 FY.CO.