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APPLICATION FOR SANITATION PERMIT Permit No. `Tv (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 N —549 JOB ADDRESS AND OCA�TION -- ------------------------------ -- - ------------ ----------- --------- Phone ---- -------------- ---f--------- ------------------------------------- ........ Owner's Name -- -------- - - �M�- '2 a-., VV --------------------- ------------ .................. Address- • - ---- - --- -------------------- -- --------------- --- ---- Phone'- Contractor's Name--- ---- - ------ ---- -- ----- -- -- ' - i _.Iw Installation will serve: Residence P91"Apartment House ❑ Commercial E], Trailer Court C] Motel [3 Other 4F El Number of living units: -/-- Number of bedrooms .-/-.Number of Lot size --- 7-�" -X/0 ------------------------ I - Water Supply: 'Public system El Community system -[I Private 2111E epth fo'Water Table-�156-ft. 01--<,clpan E] Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ tl�—y(.—oamE] Clay [I Adobe Previous:Applicdiion Made: Yes 0 No 0R ----"New Construction: Yes E] No R?" FHA/VA: Yes LIJ NO ❑ TYPE OPINSTALLATION AND SPECIFICATIONS: (No septic tank or' cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well-________________ Distance from foundation__._.__ ----- -- ---------------------------------------------------- ------------------- V, No. of compartments-----------------------Size--------------------------------Liquid depth ------------------------ - Capacity ---- Disposal Id: Distance from near�6stength well -%574 ------- Distarce from foundation --- --- �.Disfance to nearest lot line ------ j ------- 60 j -.............. Number of lines_____________! --Length of each line ------ of trench.___-- tA -Type of filter m . aferial--e -_ 9 ---------- Total l ------------ 15— --11 ----------------- -.__Depth of filter material- / 14 Seepa e Pit: Disfance to nearest well/ - ---- ------- Distancetom foundation e - to nearest lot lin-- ------ , Number. of pits ----- / ------------- Lining -Size: Diameter__._. 33 --------- Depth--,,)--- ------------------- - Cesspool:Distance from nearest 411 - - — -------- DNfEnce from fou—nd;tion ------------------- Lining material------------------------ --------------- M; ko Size:.Diamefer ----------------- --------------- ---- Depth ----------------------------------------------- ----Liquid Capacity ------- ---------------------gals, Distance from nearest well -------------- ----------------------------------Dis Privy: t I rice from nearest buil I ding ------------------------------------------- a ❑ Distance tonearest lot line ------------------ ----------- - --------- I -------------- --------- ---------------------------------------------- ------------ ----------- (clescribe).: ------ ----------------------------------------------------------------------------------------------•--------------•------------ ...... ------------ Remodeling and ingl i - , /or re P I I --------- -- - ---------------------- w ---------- , ------------------------- --------------------------------------------------------------------------------------------------------- ---------------------------------------- ------------------------------------------- --- -------------------------------------•----•------------ -- -------- ---------- ---------- ----------------------------------------------------------------------- ---------------- ---------------------------------------------------------------------------------------------- -------------- ---- --------------------------------------------------- ---------------------- ------------------------ ------ I hereby certify that I haVe preparred-Wps application and that the work will be done in accordance with San Joaquin County ordinances, fVe la and ri4s and r;qulations of the SanJoaquin Local Health District. (Owner and/or Contractor) (Signed)- ----- AJIM --- -IS (Title) If aa --------------------------- ------------ Q I I ----- - ----- -- --- ---------------------------------- By: ------------------ -------------------- - ------ --- - --------- -------- W (Plot plan, showing size Of > lot,! loc&tii-o-n' Qf "Vyis-tern in relation to S, biiiildings, 6c., can -be placed on reverse side). L—FOR DEPARPAENT,USE ONLY REVIEWft - I APPLICATION ACCEPTED BY------------------------------------- ---------- --- -------------------------------------------- DA-TE ------------ ----I--- I -t---------------- EDBY--------------------------------------- ------------------ - -- -------------------------------------- DATE BUILDING'PERMIT-------------------------------------•--- -- --- -I ------------------------------ - ISSUED ---1--------------------------------- 1 --------------------------------- ---- --------------------------------------------------------- DATE ------------ ----------------------------------- I ........ Alterationsand/orWrecommeAaflons: ------------------------------------------------------------------------------------------------------------------•---•--------....----------------•----.------ ---------------- I ------------------------------------------- ---------------------------- ------------------ --------------------------------------------------------------------- Y h------------------ ------------------------ -- ---------- --------------_________ -------------- _______ ____•--- _ ---------- ------ ----------- / ---------- ------------- ------------- -------------------- - ----- --- Z-ee i� --- ci-�- - ----- '-I --- ---- — -------- ---------------------------- ------------------------------------- -------------------- I ------------------ ----- - --- ------- FINALINSPECTION BY--------- ----- --------------------- Da.te --- 1=2-------------------------------------------------- SAN JOAQUIN LOCAL 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 1-57 F-P.CO-