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APPLICATION AOR SANITATION PERMIT Permit No. Y�a ,� (Complete in Duplicate) This Permit Expires 1 Year From Date Issued 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 a in com li nce with County Ordinance No. 549. _ t JOB ADDRESSAr�D LOCATION___ / �j- Owner's Name--- _ Phone -------------- Address-------------- l�_...---. - - ` - -- ------------- Contractor's Name `�- ----- ------ Phone-----------•------------ -------------- ---------- Installation'will serve: Residence 'Apartment House E] Commercial ❑ Trailer Court ❑ Motel E] Other ❑ Number of living units: _�--- Nu'mber of bedrooms -- Number of baths �__ Lot size — Ze J Water Supply: Public system ❑ Community system &-porivate []-.Depth to Water Table _r ft. Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobelff'""Hardpan ❑ Previous Application Made: Yes ❑ `No, New Gonstrucfio Yes �No❑ FHA/VA.Yes �No E]TYPE OF INSTALLATION AND SPECIFIGATIONSs`' X _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.)" Septic Tpk: Distance from . rnearest we-Ll--,-.,_ -:_�_.•D.i:s#an - fm_�. 9 ------fi _.. Matera-l- ---------------- No. of comatmenfs_ - ---------- depth�----- ...... Capacit ./,Z ---f- - Disposal Field: Disfance Jr6rn nearest well___.7--":-D" istance from founclation-ti, A�_1__.Distance to nearest lot line__- .-. l� Number of;iines_____-- ;0---- Le gth of each line------ -- :. , �pA♦- Width`of trench---- T e of filter material. __f De th of filter mater-ial____- d-__r____-Total length___--la�'__0______----_ Type P ----.--•-- Seepage if: Distance to nearest well____^------Distance fr m foundation----/.-p ....Distance to nearest lot line___by-------- Cesspool: _ r.1 yi[� Number of its)--- <! ♦ V" - p �----------Lmmg rrraterral:=_��_ ._..Size: Diameter_-� --t:._.Deptne�s�-____-- Cesspool: Distancetfrom nearest well-----------------Distance from foundation.-------------------Lining material__---_...___.____________---___ ❑ ' Size: Diameter-- Depth---- ----------------------------------Liquid"Capacify----------------------------gals. Privy- ,'Disfan6e from nearest well----------- --------------------------------------Distance from nearest buildingw ❑ --------------------------•--------- ' Distance to nearest lot line----------- ----------- ----------- --------------------------------------------- .a Remodeling and/orirepairing (deet ibe):------- •-------------------------------------------------------------------------=•--------------------------------------••----------.-- -- --------- -- -----------------------------•---•------------------•------- �. --------- ----------------------------------------------------------------•------•--•--------------------------•------------------------------------------------------------------------------------------------------------- --------- ---------------------- . I hereby certify that I have prepared'Ais application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rul's and regulations ofthe San Local Health District. _ ii -- -------------=----------------------------- { Gor Contractor) E (Signed)-------- Y:---- - ---------------- (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -- ----------- -- -1------------------------------------------------- DATE = = s REVIEWED BY----- - QATE UILDING PERMIT ISSUED------------------- ------------------------------------------------- -------- DATE. Alterations and/or recommendations------------------------------------ --- ---------------• - -----------------------------•-----------------------------------------------------------------•--------------•---------------- ------------------------------------------------------------•---------- -----•--------------------------------------------------- ------ ----------------------------------------- --------------------------------------------------------------------------------------- tl ----------------------------------•------------ ----------- ------------------------------------------------------------------------------------------------------------------- tl FINAL INSPECTION B ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 00 South American Street „ : „�- 00 WostzOak Streets 132 Sycamore'Strew! r 814 North "C" Street Stockton, California R '` Manteca, California" � 3 f Tracy, California Lodi, California ti jti= Fs-9-2M Revised 8.'59 F.P.Co. -