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\V APPLICATION FOR SANITATION PERMIT Permit No. (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 yATION__,,__9_. ------ -- --------------------------*-------Z_dl ---------------------------- Owner's Name------------- - --------- _j - - - ------ -- ----- ...... ..... Address...... ----------- -----------�0---- ------F------------ C—---------------- Phone//_74�....J2��44....... Contractor's lull Cr------- ---------- Name------------ ---- Phone Installation will serve:. Residence L-1 Apartment House ❑ Commercial ❑ Trailer-Court El Motel El Other ❑ Number of living units: Number of bedrooms -3- Number of baths _J--- Lo siz ------- ---- Lot e Wafer Supply: Public sysfem'Ej Community system El Private'- epfh to Wafer Table 31_ ft. Character of soil to a depth of 3 feet:- Sand E]'_Gravel Ej Sandy Loam 0 ' Clay Loam E] Clay E] Adobe [!T_-_'Hardpan b I Previous Application Made: Yes [] No [ije"New Construction: Yes El No El PHA/VA: Yes E] No 171 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest w`e'1l---- Distance from'7founclatio'n__%.�---------- Material--- --- - --- No. of compartme" nTs y- - ------------------ ----------------- Liquid dep�h__J_X!........... acify----- --��7 , �60, ---- ap -------- Disposal Field: Distance fromnearestwelf_A�0__ 401 from foundation--- -9-**-------Distance to nearest lot fine--Zo Number of lines ________f ----Length of each line----;1J___'0r -.Width of french_67-:1'!!f_---------- -------- Type of filter materia ___Depth of filter material_-_- - ------------Total length____-__ ----,r----------------------- Seepage 4f: Distance to nearest well-,e"20-------Distance /_ C� 13 Ar6r�� foundation----Ab!--tisfance to nearest lot line------ Number of pits_,_-/---------------Lining material- -------- Size: Diameter_____:_ _ Cesspool: iameter------- Cesspool: Distance from nearest well-----------------Distance from foundation----------------Lining material DSize: Diameter-------------------------------------- Depth--------------- ----------------- Liquid Capacity-- --------------------- ---gals. Privy: Distance from nearest well_________________ -----------------------------Distance from nearest building---------------------- ------------------ El Distance to nearest lot line. ------------------ ---------------------I-------------------- - Remodeling ---------I--------------------- Remodeling and/or/or repairing (describe):----------------------------------- -------------------------------------------- --------------I------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------I--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------I-----------------I------------------------------------------------------------------------------------------- ------------------------------------ ------•---------•--T------- I ------------------I------- I hereby certify that I have prepared this,application and that the work will be done in accordance with San Joaquin,Coun ordinances, State laws, and rules and regulations of the San Jo in Local Hea District. DAY&NIGHT ------------- (Signed) ---------------- --------:--------------- -- - --- ------ ��5f w7f, ff)i or Contractor) BY� 06 So.Eldorado NO 2-7046 1 1 2---------S... - ------------------ ------------- ---- r ------ -fiiii---ogf--------------------------- too ---------------- ,(Plot plan, showing size Of lot, .10ca,ion U sysfi�m in relation to ells, 6uildtn' S, etc.' can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY______________________ ------ --------------------------------------------------------------- DATE-------I& REVIEWED BY--------- - xZ----- ------------7- ----------- ------------------------- - -- - -- ----------------------------------------:----------------- DATE - ----- --- ------- A ----- ------------- -- BUILDING PERMIT ISSUED---------------------------- ___ --- ------------------------------------------------------------- DATE. Alterations and/or recommendations:______________ --- - ------------------------- -----•------•- ---------•-----------------•------- ------------- --------------------------------- - R - -------------- ---------------------- ------------- ----------- ---------------------------- -------------------------------------------------------------- --------------------- ----- ----- ---- ----------------------I-- -_--e —- --- - - - ----------- ---------------------------------------------------- ---------------- ------------------------------------------------------------------- ------ ---------------------- ------------------------------------ --------------------------------------------------------------------------- FINAL INSPECTION BY..,- -------- --- - ---- --- -------------------------- Date--- 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,C0.