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APPLICATION FOR SANITATION PERMIT Permit No. ..,1 I (Complete in Duplicate) Date Issued ____7141i:;Q { This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described: ADDRESS AND LOCATIO 'e with Ordinance No. 549. - f This application is made in com lianc I a } pP P JOB ✓- ------------------------------------------------------------- --------------- Owner's Name i-L L�ErC�L / ------------------------------------------------ - ----------------------------------------- Phone----------V -------•------- Address 'fir -------------------- ';j`} /� � �`�' = s P .. i y Contractor's Name----` --------- ihone_.__...---c-----•-•-•.-••---•-•--•. Installation will serve: Residence ga Apartment House :❑%'Commercial ❑'Trailer Court ❑ Motel ❑,Other ❑ Number of living units: _�-- Number''-af bedrooms .;. - _.� - Number of, baths _�__* Lot size _ �__111P-1-___________________ --- _ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Wbter Table '-7A- ft. Character of soil to a depth of 3 feet: Viand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam ❑ Clay ❑ Adobe Hardpan i Previous Application Made: Yes ❑ No'®�,'New Construction: Yes ❑ No FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) q Se fiici a�n . Distancce from nearest well-----------------Distance from foundation-------------------.Material----------------------------------------------". I> v/•'f No. of compartments---`--� -`--Siie-------------------- Liquid de�th Capacity Disposjal Field: Distance from nea est welll __.�_-.._Distance from founda ioin__ ------------ Distance to nearest of line__�_�___.Number of lines_ _:_ "''___ _�___Length of each line-?4__40_- �_-- h of trench--- __' ©� Type of filter material-4-7114 of filter material__,��'.________ length_-__.___A��___-------._____r' t � Distance to nearest welL_�__!-�_ Distance_f,�m fo ndation----�_�__._. s �c� to nearest lot lir,�e__ of its / �.--- _ Linin material__ _._ �r _-Size: Diameter._ -__- -._Depth__ ---------------------- Number / C s pool: Distance fromnearest well-----------------Distance from foundation--- ----------------Lining material____._____________--_----_____-_____. ❑ Size: Diameter,---'------------------- ------------Depth----------------- ------------------------------- Liquid Capacity---------------------------..gals. (11 Privy: Distance from nearest well---------------------------------------------1----Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line--------- - 11 !/ / k ' Remodeling and/or repairing deicribe :____ / •------------- � �.-.. - --- ------- -- -----------------------------------------•-------•-••---- ------------------------------------------------------- -------------------------------------- I hereby certify that I haveprepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- -r--- ----- � - ---------------------(Title)--- By: {O r ontractos� ----------------------------------------------- ----------------- ' (Plot plan, showing size of lot, location of sys n relation to wells, buildings, etc., can be laced on reverse side). j FOR DEPARTMENT USE ONLY ------- DATE------7 ZO — la APPLICATION ACCEPTED BY------------' t_i1.-{� ------------------------------------------ - ---------------- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE-----------------------------------------------. BUILDINGPERMIT ISSUED--------------------------------------------------------- --------------------------------------- DATE---------------------------:-------------------------- Alterations and/or recommendations:---------------------------------- -- ------------------------•----------------------x-----------•-----------------------------------------------------.- ------------------ ------ ---- - --------------- .._.... - - --- ---------- ---------------------- ---•-- -- :- E -------------------------------------------T/r--- --- -----------------� --------�---�------ ---b ------- ._;?�__- sD------------------.-----------------------.._. --•- -- --------- ----•------------------- ----------------------------------------------------- ---- FINAL INSPECTIO . Date ----------------- ---- -------------------------------------- SAN JOAQUIN',.LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak S49W a 132 Sycamore.5tre�t � 814 North "C" Street Stockton, California Lodi, California "�Mfanteca, California ? Tracy, California ES-9-2M Revised 8-'59 F.P.Co. Il