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k APPLICATION FOR SANITATION PERMIT Permit No. ...L. - 5`. _ (Complete in Duplicate) This Permit Expires 1 Year from Date Issued Date Issued _________----_---_--- __ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. 1 This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---------------- Y- �----------- --------•--------------------------------------- I Owner's Name--------------- ------ ------ •---:----- / �- zo- -------------- Phone_f r Address-----------_-•------iz� L. 7 s��----- -- ' ---`-�......-.._...- �. Contractor's Name--- -----------I- B�-�" 1- -�a'�'-4 --------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: .Residit ence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units _--/__ Number of bedrooms___ZNumber of baths __/___ Lot size ---------------- 'a._.. _l __s2__________ Water Supply: Public system Community system El Private El 14 Depth to Water Table ," ft, Character of soil to-a depth iof 3 feet: Sand El Gravel El ,Sandy, Loam E] Clay Loam E] Clay E] `Adobe Hardpan E];. . Previous Application_;Made: Yes ❑ aN.o. New Construction: Yes,j _NL[] . FHA/VA: Yes ❑ No. TYPE OF INSTALLATION AND SPECIFICATIONS: ;� t (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) Septic Tank: Distance Iiti I from nearest well---->d---__Distance from foundation_______r' ____.Material__ .t_.�t. ..r�-„ ,��__. No. of com artments_.___._.___:%.---------Size____ __° i uid depth-----4------ _____-Capacity -GAS___ ” Disposal Field:: Distance,;from nearest well L...aa....-_.Distance from foundation____'2._.� ___Distance to nearest lot line_______�__---' Number of lirzs--=---------------lam.- :--,` --Length of each line______'-------- 'tZ_-- Width of trench----------- ----------------- " Type of filter material'"° �%z Depth of filter material___. � Total le'n th__________________ __r________ � Seepage Pit: Distance4o nearest well______..______Distance from foundation_____ ' Distance-to nearest lot line---- KK Number of pits------ ------______Lining materiaLA'C.-f___._.Size: Diameter__.3_.4-_._______-Dept li-------2-----__._______ Cesspool: i -Distancefrom nearest vvell___________.___Distance fromfoundation--------------------Lining material------------------------------------- ❑ I Sze:: Diameter---------------------------------------Depth------------------------------------------------------Liquid Capacity----------------------------gals. 11 DistI Privy: Distance from nearest well_Y --------------------------- _ _____ .-__ ___--_-_Dista`nce from nearest building---.-------------------------------------- ❑: ,�lFto nearest lot lin`e------------------------------ ----- ---------- ---------------- -------------------------------------------------•------------ --- Remodeling and/or repairing (describe):.------- -` s------------ -------------- ------------I---------- -•------------------------------------- Y _-----___-------------------------------:'"""_*---_:____ ._`__ ________________________________________ _____________--_______-_--__ _-____-..____------------------------------------- y - i I .___#__ 1j, xs t_- I hereby certify t at I hay pre ared this application and that the work will 'be done in accodance with San-Joaquin County ordinances, Stat s, and ru es d regulations of-the San Joaquin Local Health District. (Signed)---- -- � - -- il- - - --------- ------------------------------ ----------------- ----------±---------------------------------- ,---------k----------------------------- }--------(Owner and/or Contractor ,,.. F � � y:------ ------ ----------�-----------•--= ----------------------------------- --------------------------------[---------(Title)------------------I------------------..-.-.-.--._._..---------- (Plot plan, showing size of lots, location of system in relation-to wells, buildings, etc., can be placed on reverse side). I. ( --FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- -- -- ----------- --------- • _ -------------- ------------------- - 3 REVIEWEDBY------------ M ------------------------ ---------------------------------------------- ------ DATE-------------------------------- 'k BUILDING PERMIT ISSUED-1 - ------------- DATE--------•-•-------------------------------------------------- � Alterations and/or recommendations:._- -------- ,-��. - . . =per ------ ----------- .....--- '6.1�--•----�- - ,5-------------------------------•--•------- - --------------------------- -----------------------------------------------------• ----------------------k--------- i_1------------------------- ------------------------------------------------------------------------------------------------------------------------ 1 I -------------------- -- ---------------------------------------------------- ------------- --- ----- ------ - --!N-------------------------- --------------------- ----- -------------------------------------------------------- FINAL (NSP TTbNyBY:_:h'-.....�__ - Date 4 3 - f----------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 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- Gl �i -s