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.1 APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No. Date Issued ---------"-131S-�l I------------- Application is hereby made4fo the San Joaquin Local Health District for a permit to construct and install the work h This application is made in 6rnpliarice with County Ordinance No. 549. erein described. JOB -ADDRESS AND LOCATION /'Y/ Owner's Name. % --------- - ---------------------------- Address---- .. .................... ...... ........ -- Phone------------- ------------- ----------------- ------- ----------------------- - zvta Contractor's Name-------------N! Z ---------------------- Residence Apartmlent' ---------------- Phone.,,*464 Installation will serve: House E] Commercial El Trailer Court E] Mote[ [], Other ❑ Number of living units: Number of bedrooms --Z Number of baths —7— Lot size A' Water Supply. Pu N . -_/049-------Ot�- 40_7�---------------- blic system Community- system E] Private Depth to Wafer Table/4 . Character of soil to a depth of 3 fee}: ft. Sand b Gravel Ej Sandy oam 0 Clay Loam [:] Clay 0 Adobe Hardpan ❑ I Sandy Previous Application Made. Yes 0 No, New Construction- - _ -Yes E] No K FHA/VA: Yes El No TYPE OF INSTALLATION AND SP Cl F E TIONS: (No septic tank or'cesspool permitted if public fie sewer is wailble within;200 feet.) Sel1fi 'ra-i 1 %4 1 Distance from nearest,.' ell-----------------Disfance.from,foundation-------- w No. of comparfmenfs�$----- -----------Material------------------------------------------------- ----------------Size----------- ------------ ---Liquid depth--------------------------Ca pacity----------------------- Dis al Field, Distance from nearesPwell__.$'V Distance from foundation_-_" ----Distance to nearest lot line- I,- Number of lines-A-3' Len'` th of.each line---------;_.&�a -—----------- D - - --_____r& p_-_3VWidfh of trench--------- Type of filter material Depth -----------T --- 40 T111 f fif� mafe'rial----- gr otal 'length--' iil - I - .IV---------------------------- Seepage Pit: Distance to near6st well----' f I t----------------Distance from foundation--------------___.Distance to nearest lot line El Number of pits.-..__---Y-1------- Lining material--------------------- I -I Cesspool: Distance from nearest well-----------------Distance-from _Size. Diameter------------- ---------Depth------------------------------- - El Size: Diameter------ I foundfation--------------------Lining material-"---_-"___-___-_----_-_- ------------ ------------ --- -----------Depth-------------�;------ -------------:---Liquid Capacity-1 Privy: Distance �rom nearest i rg'st weO jr 4 ----------- ---------------gals. well_________________---____-__________._._____-._Distance from nearest building---------- ---------❑ ----------------- ------- D;sfance to no arosfd, t lire ---------- Remodeling and/or repairing (describej,-_-�_---__I- ----------------- -- - --- ------- ... .... ------------ ------------ - ------- -;z;.V Z:.;�--------------- ---------- ---------------------- ----------- ------------------ _1---A� _16� ------ ----I- ------ - ------------- ----------------------- ------- ---- -- - ----------------------------------------------------------------------------------------------------- _-__L—---------- ----------------- -------- �_E I hereby certify that I have prepa' ------------------------------------------------------------- red this application and that the San Joaquin County I the�;,rjoa [ain ordinances State laws, and rules and ri� jo ;11 be done in accordance with ocal :;��ealth District. (Signed)-,------------------------------------------------ --11, By:---- 0 --- --------- wper and/or Contractor) ------------------------------------------------------------ ----------(Title)---- Me2 ------------ - ---------------- - wells, b �nr, ----------- - ------------------ (Plot plan, showing size of lot, location 'of system in relation to wells, bui n9s, etc., can be placed on reverse side-,). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_Q REVIEWEDBY------__---- ------ - --- - - ---------------------- ----------------------------------------------------------- DATE_i:�7-------------------------------------------------------- BUILDING PERMIT ISSUED ---------------------- ------------------I----------------------------------------- DATE___�-------------------------------------------------- Alterations and/or recommendations:----------------- --------- ecommendafions:--------------------------- -- ---------- ----------------------- DATE---------UZ -------------------- 66--------------------------- ---------------------------------------------------------------------------------------------------------------------------------------I---------------------- --------------------------I--------------------------------------------------------------------------------------------------------------------- -------------------------- ------------------------------------------------------------- ------------------------I------------------------------------------------------•---•------•---- ---- -----------------------I------------------------------------- ------------------ ------------- -------------------------------------- ---- ft ------------------------------- ------------------ ---------------- ------ ,L ------------------------------- -------- --------------------------------------------------------------- FINAL INSPECTION By------ ---------------------------------- Date.- _Z __��------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 00 South American Street 3 1 00 West Oak Street 132 Sycamore Street 914 North "C" Street Sfock+on, California I I Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P,CO,