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\)APPL.ICA�ION :FOR` SANITATION PERMIT Permit No. �•_ f_.7` . I _ _ (Complete in Duplicate) / This Permit Expires I Year From Date Issued , bate Issued .._...tf__f Zr 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 Wo. 54414�� 9 DDRESJOB,AQ --- ! ----- Owner's Name--- -- ---------- - ---------------- Address__ (l ----•-•----- 1 ------------- ----� ----------------- k _ I I + --- Phone f�--- Contractor's Na e-------- ----- -�----- -� ------ f # r�, ^ � �� Installation will serve: Residence Apartment House i�'n me�cial ❑i Trader Court ❑r"1. %. ❑ Other dl �f f 1 . Number o living units: . r of baths __ Lot:size __.��- -------------•------- -- --- ---- --- Number'of bedrooms _ Number Water Supply, Public system �Commuriity system ❑ Pnvate ❑ Depth to Water Tables_ Character Qf soillto a depth of 3.jeet: Sand ❑ G'avel ❑ Sanldy L'oam4o/lay Loam ❑ Clay ❑ Adobe�i�ardpan ❑ Previous Application Made: Yeso ❑ New Construction: Yes ❑ No 2j- FHA/V'A: Yes ❑ No ❑ Il TYPE OF INSTALLATION AND(SPECIFICATIONS :_' F (No septiatank or cesspool permitteA if pu611 ewer is available within 200 feet.) { *.. *Tank: Distance from,nearest wall----_-----_----:?i_-Distance `from foundation-----------------Waterial-..-_...--------------------___-_--__._____-_---. No. of compartments---- ---------- ----------Size--------- --------------Liquid depth �.--------------------Capacity--•--- ---------------- �- ! '�. *�_ Distance from nearest ell Distance fourdatio�___-,�.-�- ___.Distance to nearest lot line__________ r fj ��'...Vol idth\f trench----- ------------------- me 'r � Number of lines____._ g each 'lin' �� ---- I Typa of filter material___ / Depth of filter material____-$____.__..Total length____________________ _____._._ . � e Pit: Distance to n�arest wells__- ----_--Distance F f ndation----3-49------.Distance to nearest lot line----------------- 3 #[� Number of pi`hs_--._>�__.t--�_�-L-in�ing-material_- _ _ _._-.Size: Diameter-_33.- -____Depth-- _�I_____________________ . Cesspool: st�ance—fc. earest well-----------------Distance froth foundation-______--._-_-.-.Lning material-______.-._.._----------_---_-.-.-_ . Dilr` ------- ---------- ------- ------------- Liquid Capacity❑ Tteamet - ------------- De thgals. \ q Privy: ,+,.�F ( Distance from nearest.well_________________ _________________--._.__.---Distance from nearest building-_.---_-_-_-------_--_____--_---.__. � ❑ .:; � Distance to iearest�1oPlin�-�---�----------- -- -------------------------------- ------------------------------------------------ -------------------------�--�-� Remodeling and :or repairing describe � 111 f . � ' ---------------------------• f-------•--------------- ------------------------- ----------------------------------------------------------------------------------------------------------------`------------- ------ ----------------------------- --------------- -------4------------- �f--- :----------------•------------------------------------------------------------------------------------------- -- ------------- -----------------------------•---------- --------- ------------ =:x ---------- I hereby that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, t �e'I ws, and r es end r lations of the San Joaquin Local Health District. (Signed) rl� �' I t (Owner and/or Contractor) r✓.i lSrS.r�4. #fel/ ----------------------------------- �� - ---------------------------- (rtle) r i (Plot plan;--shpwing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). # FOR DEP RT ENT USE ONLY APPLICATION ACCEPTED BY------- --------------•----------------------- DATE REVIEWEDBY---------------------------------------------------- -- -- --:- -----------------------------------•- DATE------- --------- ----------------------------------- BUILDINGPERMIT ISSUED-----------------------------------------------------------........----------------------------------- DATE•-------------------------------------------- •------- Alterationsand/or recommendations-----------------------------------------------------•--------------------------- -----------•---•--------------------••-------•----•-----•--- --••------------ _.. ' -----•--T------ -------- ------- -----Q-1; ------------------------------- ' I ---'------------------------------------------------------------- -- FINAL INSPECTION ---------'-I--="------'----------------------- Date------�----��- -�--�-�------- -- ------------ SAN - ------•--SAN JOAQUIN LOCAL HEALTH DISTRI 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca. California Tracy, California I ES-9-2M Revised 6-'59 F.P.Co.