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SANITATION PERMIT Permit No. -_-..1-G-------S APPLICATION FOR SAN /10 / [Complete in Duplicate] Date issued _-__---,:,:/-- +.: This Permit Ex ices 1 Year From Date issued de to the Sari Joaquin Local Health District for a permit to construct and install the work herein descried. Application is hereby ma { This application is made in compliance with County Ordinance No. 549. _ ION. =": N - G� Rhonel7.O-- -"� - t"' OB ADDRESS AND=LOC, -_ -" - _-:_ ----•---- Owner's Name___ •-------------•--•-- ---------------------- Address__.--------- ..-- ,1":"- ----------------------------------- Phone. — ---------- -------- y Contractor's Na -----'---- Trailer Court ❑ Motel ❑ otherJ -- I installation will serve: Residence Apartment House ❑ Commercial ❑ -, K _ o size ------ - --- - - Number of.living units: -l Number of bedrooms _-" �e4 }oter, able _.---- Co�Kmunit�r Y sYstam` Private ❑ p Water Supply: P blit system ❑ Cla /Loa ❑ Clay ❑ Adobe' Hardpan ❑ i 1 Gravel Sandy Loam [) Character of soil to a depth of 3 feet: Sana ❑ No ®, FHA A: Yes ❑ No 1 New Construction: Yes 1 Previous Application Made: Yes ❑ o .. TYPE OF INSTAL►LATION AND SPECIFICATIONS: [No septic btank or cesspool perm itted if,public sewer is available within 200 feet.) ' / Distance from_foundation____-✓ --- -.Materia!__...-___ " ------ Septic Tank: ;. Di�tance from nearest wO----J_-- Size....----- �� Li uid depth---------'�-- ------{Capacity------ x G N l of compart�ents------------ _--Distance to nearest lot line__, ---------- Distance from foundation.-"/.-- - Width of trench__-- --- --------- Disposal Field:: Distance from neares#;well fy . i" _Length of each line__--___---- - dumber of lines_____ -,1-- - . -- - / `i+ Type of filter material--""��---�--�--- --Depth of filter matenaL�.. Ga - Total lengt t .___.Distance to nearest lot line--.-- t ine_ ---- w Size: Diameter , f .Depth------- If �,} Seepage ., X 1 Pit: Dtistance to nearest well '-eq' Distance from fou anon___._ Linin material_- Y! Number of pits_..._-,/--------- g Distance from foundation--------------------Lining material-_------------- Liquid Capacity------------- gals. Cesspool: Distance from nearest well--___------ .§ ❑ S"' : Diameter-_-- = -----[-------Depth-------------- -- --------------- "" Distance from nearest building--------- - ' i --------------------------------- -- - Privy: � Distance from,nearest well ----- ----- ---- ----------- --- --- ----- -- _----------------- ------- F ____________________ l ❑ Distance to nearest lot line ----- -------------- Remodeling,and or repairing (describe):------------------ - - --------------- ------- --- -- - -- ----------------- , ------------ --I------------------------------------------- - -------------------------------------- prepared � ----------------------- ---�-"-- �-- - lcation and that the work will be done in accordance w�th San Joaquin County I hereby certify that I have this app ordinances, State":laws, and rules and regulations of the San Joaquin Local Health District. (Owner and/or Contractor) (Signe --- --(Title)------ ---------- ------ �- - ---------------------------- . _ -_. .[T - BY- --- -----A. = buildings, etc.,11 can be placed on reverse side). (Plot plan, showing size of lot, location o system in�relationwtoPwells, jj FOR DEPARTMENT USE ONLY,\ )kY E4 DATE APPLICATION A6CEPTED BY ----_ DATE---------------------------------- --- � --�-- ----- -- - ----�- ---- ------------- ----- -------------------------------------DATE----------------- -�---- - ----- -- REVIEWED BY------ ------------------- - -- BUILDING PERN41*ISSUED------=- - ... p " �-- -( - Alterations and/ recammerd'ations:._._ '' --- ------------------------ ----------------------------- rCJ -- ---------------------------Ar__ 1 .. t-frxs. - --- . ------------------------------------ ------ --------- = i Date---- --------- ---- ---- - ---------------------------------------------- -- ---------- FINAL ---------- ------------ FINAL INSPECTION BY:----- --- ----- -----•------------------------------- 814 - - - ------ - - SAN JOAQUIN LOCAL HEALTH DISTRICT 131 Sycamore Street 814 North "C" Street 300 West Oak Street Tracy, California 1 130 South American Street Lodi, California Manteca, California stockton, California ES-9-21\A Revised 8-'54 F.P.Co. _