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APPLICATION FOR SANITATION PERMIT Permit No. _1130-(o {Complete in Duplicate] Date Issued This Permit Expires I 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. This application is made in compliance with County Ordinance No. 549.' JOB ADDRESS 'AND'LOCATIOH--f 7 -------------------------------------- ---------------- -- ------------------------------------------ ---- i;�3�4q Owner's Name ------------ ----------------------;tel/ --------------------- el.wv --ll------- ------------------------ --------------------------------- -------- Phone---------------- ------------------- Address________________________ ;i Contractor's Name --------------- ------------------------------ ------------------------------- ------------ Phone _ ---••- -1 7- ----------------------- Installation will serve: Resideric's)5 Apartment House E] Commercial E] Trailer Court E] Motel 0 Other E] Number of living units: Number of bedrooms Number of baths __(---- Lot size -------- Y________ __----------- I -------- Water Supply: Public system Community system El Private Ej Depth to Wafer Table -------- ff. Character of soil to a depth of 3 feet. Sand E] Gravel E] Sandy Loam El Clay Loam [] Clay El Adobe E� Hardpan E] Previous Application Made: Yes E], No JM New Construction: Yes No 0 FHA/VA, Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool,perrniffed if public sewer is available within 2Q eet.) Septic Tank: ly Disposal Field 0 Seepage Pit: El Cesspool: 0 Privy: El Remodeling Distance from nearest ''Well____ --- Distance from foundafion__'_4G ------- Materiai 1(l/e No. of compartments ------------ A - — --------- Size --- Liquid depjh -------- ...... -11 ---------- Capacity--- Distance from nearest well__d-~'�' ----- .- Distance from founclation_Z-1-2 -- ______Distance to nearest lot line____- ine---- � Number Number of fines_________________Length Type filter Zlength___--_ of each Iine ---- of french ------------- -of '-_.Total _- of material____ --Depth filter material ------ e-? -,r,' length --- -----------------------Distance to nearest well- ---------------------- Distance from foundation ------------------- Distance to nearest lot line ---------------- Number of pits---------------------- Lining material -----------------------Size: Diameter----------------------- Depth -------------------------------- Distance from nearest well_________________ Distance from foundation ------------------ - Lining material -- ---------------------------------- Size: Diameter----------------- ----------- -------Depth-------------------------------- ------------------ Liqyid Capacity ------------t---------gals ------- Distance from nearest well ---------- ---------------- !t . ............ A ---- Distance from nearest building ------------------------------ ----------- Disfance to nearest lot line--- -- ------------------------------------------------------- - - ----------------------------------------------------------------- ......... 64S and/or repairing (clescr11 + 6):--. roa vo? ----- ------ la -S ------- - -------- --------- r�_C_v ek 5-P ------ 4_Fie r a_ -A ------------------------------------------------------------------ ---------------------------------------------- 1Z_ .. (1% ---------------------------------------------------------------------- ----------- I ---------------------------------------------------------------------- 72 - ----------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will b6 done in accordance with San Joaquin County ordinances, State laws, and rules and regulatyionsof he San Joaquin Local Health District. (Signed)_."- Z - -------- ---- --- ------ ----------------- --------- ------------------------------------------ (Owner anr/F"I-P�� --- ----- - ----------------------- - --------------------------------------------(Title)------------------------ (Plot -(Title)------------------------(Plot plan, showing size arlot, location of system in relation to wells, buildings, efc., can be placed on reverse sidi-l- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ---------- �. ...... -T------- ----------------------------------- -- DATE-------------- ;-2 REVIEWED' BY----------------------- --------- ---- ------- -------- 4 ------------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED ---------------- ------------- DATE ere;;" eo Alterations and/or recommendations: ------- 1;�_ tz;" _. "I • ---------------- - - ---------•--------------------------- -- &I/ ------------- _--------------------• ------------------------------- ---------- ----------------- - ------ ---- ----------------------------------- -------- ------------- ------ -------------------- - ------------------- ---- - ------- ------ --------- 1/2 -- -------------------------- --------- -- - --------- - --------------- --------- - ---- ----- -- �Z_ ........ ...... .. - ------------------------------ - ------------------------ ----------- -------------------------------- ------------ -------------------------------- ---------------------- FINAL INSPECTION BY:_ ----------------------------- ----- ------------------------ Date ------- ---- ------ ---- --- 0 ------------- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRIC 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2m Revised 8,"59 F.P.Co.