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{`I APPLICATION FOR SANITATION PERMIT Permit No. _40_4 (Complete in Duplicate) �. _Date Issued .9/7A; - 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 Ordina ce No. 549. ' JOB ADDRESS AND LOCATION-_.--_"- A _---__ ,� : Owner's Name-------- _ - i -_ ------------r-- Address Pho ..----------- >f` -P- V!"- -W------ lG.f/---•- ----------- /" --------------- Contractor's Name-------- - �:.� ---=-�t----•----- -- -�' /�,�'�I,�-_�t�"�.�_.�— . ----------------------------- Phone- -29�_ 0� Installation will serve: Residence Vi Apartment House ❑ Commercial ❑ Trailer Court `�-- # ❑ Motel E❑ Other ❑ I Number of living units: _ _--- Numberfof bedrooms -- Number of baths __. - Lot size ---.. _-- ` "' Water Su I "'Public system Commuriit s stem ------------ PP y� Y y [] Private ❑ Depth to Water Table`�6' ft. r 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 ❑ NoFHA/VA; Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or`cesspool permitted if public sewer is available within 200 feet.} k ` omSe ti Distancernearestwell--- -------------Distance from foundation------ Materia!No. of compartm' ents S -------------------------------------------- ------------------ ze--- Liquid de Fh�Dispo " DlStdnCm ------ - ------Capacity-..- gel nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-."--_____-"--.-- Number of lines---- ----------------------------Length of each line----------------- ----------- Width of tronch ------ r Type of fitter material--------- ---- ---- ----Depth of fitter material-----------------------Total length----------------•------------------ je e Pit: Distance to nearest well---- 41;-_-Distance ;�� foundation--_ Number of pits__-_. _.-__"---_--Linin material----_ Dista`�to nearest lot dine--- --_---� 9r. ,:. . gF�Size: Diameter---��.- _" ------.De th--- ,- P ,.----,L------------- Cesspool: ` Distance from nearest well_---"-_- -.---- Distance from foundation-------------------.Lining material_--------------_--- ❑ Size: Diameter--------------------------------------Depth ------ r ----------------='-----Liquid Capacity------------------ gals. Privy: Distance from nearest well------- ------ T' f. -------------------------------------------- from nearest buildin ❑ Distance to neare1 .1st.lot line ---- g-------------------------------------------- ------------------ o =----•--- --------- --------- ---- Remodeling and/or repairing (descri ed:._. _ " If jf ----------------------------- .. �i. `' - - -----•-------•-------=--------------------------- ----------------------------- ------ --------------''----------------•------- ! hereby,certify that I have" repared this applicatio nd that the work will be done in accordance with $art Joaquin Count ordinances, State laws, and r s nd re la#ions of e S Joaquin Local Health District, q y ' (Signed)--. - ----- ----------- ----- = 'w r�� y z„(Owne�and/or Contractor] F- -- [� -------------- By------------------------------------------ (Plot ^� . __ - [Title} ,�• r �� plan, showing size of lot, location of system in relation to wells, buildings, et an be placed on reverse side). . -- ------------------ } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-_ REVIEWED BY -------- _ DATE -------•-------------------------------------------- --------------------------------------------------------------- DATE --._�- BUILDING PERMIT ISSUED-___---_- ? -____-__ ---------------- ---------------------------------- ---------•------- ---- DATE------V Altera#ions an-dor.re mendatio s: --- ------------------------------•--- = `5 c -- - F --------------------------------- = ---------- -- - --- ------------------------- ------- - ----------------------- ' ----- FINAL INSPECTION BY:.-: ---- --- -- Date-------- -7 ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Streetn Stockton, California 814 North C Street Lodi, California Manteca, California Tracy, California ES-9-21+'1 Revised 1-57 F.P,CO.