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FOROFFICE USE: ------------ -------- `------ " i.?_*------------------------- APPLICATION FOR SANITATION PERMIT Permit No. Complete,in. Duplicate) - - -- --- This Permit Ex ires 1"YeaF'F'rom'Date"Issued-4 Date Issued .......... ... Application is hereby made to the San Joaquin Local Health District for a permit to constructand install the work h rein described. This application is made in compliance with Ordinance No. 549. I° —._ 'W ! PQM• JOB ADDRESS AND LOCATION__f�{ilk=-___.-__-T ---FSON .� �. FA Owner's Name_-.-•--------A-0.._...._-_-i._}�_l}-K-----../N 1 ------ Phone Address...... -- = �� Contractor's Name. - T +L 01�- _ ---------•----------•------------ Phone................................... Installation will serve: Residence Apartment House ❑ ComMrcialTFE JICTrailer Court ❑ ❑ Motel ❑ Other ❑ Number l9 --I---- of des . mbetvffb*t;sW Lot!sizesize _ Water Supply: Public system ❑ Community Priv to Depth To Water Table Z. ft P P ❑ I ❑ o Y ❑ Y � Y ❑ Adobe❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand ravel Sand Loam Ga Loam Cla Previous Applicali3n Mader (I'f Yes,dale--.-..._____-__-_ _l No New Construction: Yes tE No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONSy (Nod septic`tenk or cesspool permy�itFed if public sewer is available within 200 fe`et.) Septic 7 : Distance from newest well ------Distanc�from foundation-------_-- . __--Material-__---_-----..-_-_--. --_ ---••--- 1.C�— No. of V ......... -----••------- -------Li_Liquid de th- Capacity C C ,. Disposal Field: Distance from nearest well---.�� ----DistanJfrom foundation----_-, -.-.-.Distance to nearest lot line.... WY�liSrnbertof eines_--• if FX f1 #. -----------1------Length of each line------------------- -----Width of trench P Type of filter material-----------------1-0--Depth d44_fi'Ifbr-material:—�--------t.-_-.-Total length----------...--------------.-.-•---------- YP - See Pit: NumDistberof to nts res well-_---1�- N__Distan from foundation_... _ _. • ,��_____-_.Distant #nearest lot link....- p Lin' g WTlaterial.- 0<,K Size: Diameter-1�,�__.__ •-Depth---_ -..-__---_-.!'�.- Cesspool: Distance from nearest well-------- --- -Distance from foundation-.___------ ----.Lining material,------------------- I Size: Diameter----------------------------j------Dept k--------- - ---------.Li Liquid Ca Capacity-, 9 P tY----••----------•----••----.gals. Privy: Distance from nearest well---- ----- --------------- -------__..-__.-Distance from nearest building ❑ Distance to nearest lot line------------- g - R � and/or repairing a!iPring (describe describ.-eRemodeiin - .HrSA."�xI ' Rr-- Ta -- F-4 ------',0.-- R-rnf.. . Aa�A . 1nr'ST4-1-A-:iiia-. ------�0WN------------- -K.-`--- ---------------------- --•-------------- ! hereby certify that I have prepared this application a d that the will-be-done in accordance with San Joaquin County ordinances, State laws n les an a'laftons of the Joaquin Local%HealthD istrict. , (Signed)------------ ----- ----- -- . ---- - [Owner and/or Contractor) Qr , .t ----------------------------------- '(1' Plot Ian, showing size of lot location of system.in relation to wells, buildings, etc., can be = =_: it _____ P � � � placed on reverse side}. T t FOR DEPARTMENT USE ONLY /' k APPLICATION ACCEPTED BY ? --------••----------------•--- DATE..----- .'_��.��_------•-------------- REVIEWED BY--.. ---- ----------- I-------- --------------- DATE--------•---------.-_----.. UILDING PERMIT ISSUED-----------------------------•----==--------------------------- • - ------------ DATEAlt . - - -------------•-•--- erations and/or recommendations:------------------ LZ--- FINAL INSPECTI Date........ -. _ _.'- . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California E5 9 REVISED 8-59 2M 5-52 arias Manteca,California Tracy,California