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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued -_/y �s'� Applicafion is hereby made to the San Joaquin Local Health District for a permit to construct and install th work herein i This application is made in.compliarice with County Ord_inance.No..549.,�_ 1 descriliecl• JOB ADDRESS AND LOCATION____""-_ �� _ -- ". --_-.-- - _ -- -- ------------ -------- Owner's Name------- --------1-.-- p}� / l ------ Address--- _ _ M - I.. - ---- -a- n-------- --- ---------- -------------- Contractor's Name--------------"-- 7 Installation will serve: Residence --------""""-------- ------------------_ Phone 7(1-------rt, (Q Apartment House ❑ Commercial ❑ Trailer Court i PP y ,( / ❑ Mofel ❑ Other ❑ living s--- - Number-of baths :_ Lot size Water Somber Public system Nurriber of bedroom - �. � f of Y 04-Comm4n'ty system ❑;Private Character of soil to a depth of,3,feet: Sand ❑ • Gavel ❑� Sand�oaDepth•fo Wafer Table 1 ' Previous Application Made: Yes Y ❑ y,Loam ❑,,,Clay ❑—Adobe ❑ No E]:. -New Construction: Yes No ► , Hardpan [] TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ FHA/VA; .Yes ❑ No ❑ t � 7i. IA1 I (No septic tank'or'cesspoal permitted.if.public sewer is available within 200 feet.) 7/ I . ... r - S Distance from neares I_j""_ Distance from foundation----:__-- _"-_""-.Mate'_ " No_ of compartments--:_-,-----h------ +size_ t # Liquid'sal Fuld: Distance from nearest well --" uid depth--------------- ---------_Capacity. I ' - .. _ . d ----- ` - - __.Distance from foundation____________"�__-_-Distance to nearest )of line_________________ Number of-lines_____-------------`" "-��Length of each line--�------"_"_-- . -- Type of filter material-=--------------- -------Depth of filter material----- =-":Total hlengtof french nch" " "" 1 Seepage rf: Distance to'nearest"wkell" D f ��""" -" -- -- ____Disfance.from foundation - rw R p____Distance to rreares+�lot line___ . " Number of Arts "_� - -- --Lining rnaferial__ p- _ rr ._ --�---- }� n Cesspool: Distance frorrr nearest well__ 1 Depth-_ -- 5--�---� a ----------"_"__Distance from foundation________""-_-___"_ N Size: Diameter"" ' ❑ Size: Diameter 1 t }' Depth -L in ma erial------ in g t Priv ;� E t - - ----- Liquid Capacity Y Distance from nearest well El :___.- -----_ ---Distance from nearest building Distance to nearest lot �__--_.-_ ` + .. 1! ' Remodeling and/or repairing (describe:_____--_._____ I ------------------------- ----------------------- -------------- = f-=-------------------------------------------------------------------------------------- =�, �1 pr a {---------------------------------------- -- ------------------------------- -------------- I hereby ca�Ilayws, have preparedthis app9ication and that the,work will be done in accordance with San Joa uin ordinances, Stat `ules:,and r- lations f +he San Joaquin-Loca Health District. 9 County _ F (Signed) y ---------- -�EI� _: 11 --------- ----------- By:------------- -•-•- Contracfor) •------ .............._Title_ _ 4 . (Piot plan, showing size of lot, location of system in.relaf' n to wells buildin : , efc., can be p aced on reverse side):_ I. FOR DEPARTMENT.USE ONLY �, 1 APPLICATION ACCEPTED BY____-____-""- __ y REVIEWED BY__- 1 =------ � -- - - ----------------------------------------------•------------ DATE-----------•---=-'---��------------------------ - -------------------•------ ------- �).----------- - ---- -------------- DATE-----------.----------------------- BUILDING PERMIT fSSUED----------------------=-- -- ------------------------,.•i„_, .--------.---- Alterafions and/or'recommendations:_ """"-,- -- - "--" "- # L .. ----- ...... ATE ---------------------------------------------------------------- ----------- ,: ---- -- ` _ 4 __________ _ 4�7-474. ------------------------- W-----�Ale------E2 ,, - ------- -----/�`Q7` t -r .�r �'cam""---- 77� ------------- ------ FINAL INSPECTION-BY:.__ --------------------- Date- --- _ =' AN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street T Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F•P,CO.