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APPLICATION FOR SANITATION PERMIT Perm •-- Q , (Complete in Duplicate) Date Issued .... ' '-4-- U This Permit Expires 1 Year From Date Issued 0&-et_ '0o -Z•Z Application is hereby made to fhe San Joaquin Local Health District for a permit to construct and install the work herein described. r_ This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.-.. J W---10.-.P Owner's Name............ = a --- Phone.-----------•------------------•---- f----___�___"' RA....._f_'-10_B!e-__ �a.t .,n 5 ________________________________•--__..___ Address---•- - .�- - -------•----------------=-----------�-----------------------•------------,-----•-------------------------- , 'AP _.'�� '------- -------------------------- Phone---------------------------------- Installation Name--------•------------ -- ------------------•--- ------- ----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Tra' Court ❑ Motel s C] Other [I� Number of living units: ---/_- Number of bedrooms __S Number of baths ___"� of size Water Supply: Public system-❑• Community system ❑ Private Ug- Depth to Water Table _ Character.of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 93-_T�a ❑ ti FHA/VA: Yes g?--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic Tank: Distance from nearest welln_ -______Distance from foundation----___ _ th Material 6'--li ac,�f' No. of compartments_.____.rc---------------Size--,-�---7F� it Liquid d p �$, f , Disposal Field: Distance from nearest well-JR-----Distance from foundation_.-.,/f-..-----Distance to nearest lot I�!__ .-- Number of lines-- --- -------- -- ----- -----Length of eae-fch line---� --------------Total hien length of nc � _`�--------- -`_ Type of filter,material-_ - � epth of filter material_----� ® .D'st nce go nearest lot line___! ---•--- ` Seepage Pit: Distance to nearest well__,l__��------Distance fro foundation____.._ 1 Number of pits----- -------Lining material--- &/V,-Size: Diameter__ �i------Depth-_. �------- I Cesspool: Distance from nearest well-_--_-._____..__Distance from foundation Lining material-------------------------------------- ----- -------Depth---------- -------------------------------------Liquid Capacity-- .------------------------gals. ❑ Size: Diameter_______________________ _ ' st well-__.____________________________ Distance from nearest building------------------------------ -------- Privy: Distance from neare ❑ Distance to nearest lot line------------------------------------ 47 -----------------------------------------------------s , Remodelingand/or re airm descri a :_____ .__._ ------------------- .- -------------------------------------------- - ------- ----------- ---------- -- - ---------•---------------------------------•------------------------------- - --ccor with - a -o ui I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a;0 rules and regulations of the San Joaquin Local Health District. -- (9rn,er"ead.j�or Contractor) -------------------- ---- ,�/___-- _ - __________________________________(Title)_____ �lv7e"4-- ` .-_.... ----------- (Plot plan, showing size of lot, location o stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ ----- ----- DATE / /.cz--------------------------------- REVIEWEDBY--------------------------------------------- ----- - --------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------- ---------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------------------------------------------------------------------•-----•---------•----------•--••------- mo _ _ _ __ zK ------------------------------- ---- _ - -------- ----------- ------- ---------- - --------------- r -------- ---------------------------------------- - .. - - --- IO Date- — ---- ---------- ------------------------------c � FINAL INSPECT - --- --- ----- ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C' Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y e ES-9-2nn Rev'�sed 6-'59 F.P.Co.