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` APPLICATION FOR SANITATION PERMIT Permit No. 74-, -7 (Complete in Duplicate)This Permit Ex ires 1 Year From Date Issued Date Issued ___ - � Application is herebymade 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 LO ,. ------ ---�T-=I-O- N.f- Owner's Name------------ i.----------�� TL ------------- Address--------- ---•--------Address-----••-- r 1 �� -------------------------------- ---------------- ---.-. Phone-------------------------- -------- - ----------•------•- ---- PhonContractor's Name____ e._Installation will serve: Residence �]I Apartment House [J Commercial ❑ Trailer Court ❑ Motel Number of living units: - _____ Number.of bedrooms ❑ Other ❑ Number of baths __ _.- Lot size PPY� y _______. Wafer Supply: Publics stem ❑ Community system ❑ Private Depth to Water Table _ �- ft. Character of soil +o a depth of 3 fee�: Sand El E] San y Loam E] Clay Loam ❑ Clay 0 Adobe)` Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS-, '%, %4. (No septic tank or cesspool permi+ted if public sewer is available within�206 feet.) . Septic Tank: Distance from nearest well-----------------Distance from foundation_-___ ❑ No. of compartments--------------- Size----------------_ _ -•-------- --------------Liquid death---•----- ----- -------Capacity-•--- - ------�- DisVil Field; Distance from nearest well' �` / JV--"" Distance from foundation_._1p7t-_"__.Distance to nearest lot lin f. -of lines---•-------'/--- ---- --------'Len th of each line__------�Q----'------.Width of trench....... r Type of Iter materiel_- 0C_'__Depth of filter material �._-.. _..Total Jength______ 50 --_" See ge P Distance to nearest well--''��?0 istance.from foundation__,/ ' �yfcj' _F?__ _____.Distance,fo nearest lot line__.-. Number of pits_-_._____1_______- Lining material Diameter_- p t- __ ' De tn_. =@25�------------------ U Cesspool: Distance from nearest well-----------_------Distari _ .__ ce from foundation _._-_________ -.Lining material__.__._._-.__.__ Size: Diameter -----------Depth-- ------------------ --- - i = Liquid Capacity-_- Privy-,Privy; Distance from nearest well ---------------- ----------------___Distance from nearest building �.} Distance to nearest lot line_ _-""_---"__- r .� 9 ------------------- ------. --- -- ------------------------ Remodeling and/or repairing describe • ______� = �" ------ -- - -- - ------- I hereby certify that have prepared application and that the work will 6e done in acco ordinance;, S+ate laws; r sand gula 'ons of the an Joaquin Local Health District. rdance with San Joaquin County (Signed)__------ ,. -- - ---------------- BY ---------•---------------------------•--------- "' _ an Contractor) -- --(Owner or ontra orl - --�--�- - - --- - ---- -- (Title) � •-- � , g ------ (Plot plan, showing size of lot; location of sys+e anon to wells, buildin s, c can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY_____ _-REVIEWED BY ------ - ------ --------- --------- ---------- �----- DATE------- --•�---`�---------��-,-�- -------- - --------------------- -------- DATE ----------------------------- UILDING PERMIT ISSUED .......................................... -------- ---------- - ----------�-- ---------------- DATE. ------------------- terations and/or recommendations________ ___........................................... ____- I --- = 4s - ---- - ----------- - ----- - ------ ---_------ ----------------- ---------------- ------------------------------------ --------------------------------------------- ------- FINAL INSPECTION By:_ -------------- - Date------- j ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stocktart, California Lodi, California Manteca. California Tracy, California fI Es"9-2M Revised 8.'59 F.A.Co. - [