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rUK Ut- I—t USE: ,,,.�.. iiiil— ---- s - ------------------------ _____________ APPLICATION FOR SANITATION PERMIT Permit No. .,-V- ---- --------- ----- --------------------- --------- ( P to-in Duplicate) --------- -- ----- --------------------- ------------ _. om le ed Date Issued .�-_�-5--•,rp 7 This Permit Extsires 1 Year From Date Issued Application is hereby made to the San Joaquin ool - Lsb—cf3 This application is made in compocal Health District for a permit to construe install th w rk herei ascribed. f liance with County Ordinance No. 549 +. JOB ADDRESS AND CATION.- c' 7e f Owner's Name. _ ------ -� �.------- �_. Contractor's Nam e_.__. ------ - •y Installation will serve: Residence E❑ Apartment House Commercial ❑ �roiler Court ❑ Motel .[] Other - Number of living units:'"��Number of bedrooms :'' � � / if Number 6f baths _ ot size __ �4 -X� . -(�___ Water Supply: Public system E] Community sy m �rivafe ❑ Depth to Water Table 80_ - ft ' f _ Character of sail to a depth of 3 feet• ,Sand Gravel ❑ ' S -Made; I No ❑ New Construction; Yes No ❑ ❑ FHA/VA: Yes ❑ No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pe'rniffed if public sewer is available within .240 feet.) Septic ank: Distance from nearest well/AA0 .,: ,Distance fro foundation------ -O -1.- Material_____ _____ _____ ___ ............ � No, of compartments--------->—_.-------?`Size .�_X _�+(Xa.Liquid depth..... - -- Capacity fl p ei`eld: Distance from nearest welf-44.1.._Distance from foundation-- . 0-a--..--Distance to nearest lot line sr i Dis o�s Number of lines --1---------/--_._:.-::}.�.._ Length of each lineg�_ ---------. Width of trench-- j Type of filter material___.--4__ ZZ- .-=©epfh of filter rnaferial_--__ `' • -`-Xr---- - --._Total length----�(�------------------------------ Seepage Pi#: Distance to nearest well______________________Distance from foundation.__--_----_____._,• Distance to nearest lot line_.--__--..__-_-- ❑ Number of pits--- ----- L-fining material Sipe: Diameter`.y-_ "`-' Depth------ ---------------------- Cesspool: Distance from nearest-well _,_ __Distance from foundafion....-_..-_ -.- _Lining material_____.-_----___-.-___---_ ❑ Size: Diameter. __ -- eptly •:.:.::- -----=-.Liquid Capacity----------------------------gals. Privy: Distance from nearest-well. ... _----:--.:Distance from nearest building--'-- ---------------------- ------.. ❑ Distance to nearest lot line :,:::.:..: - 4 _ _______________________________________________ Remodeling and/or repairing (describe):.......................:...` -------------------------------------- ------------•- ---------_,:------------------------ ------------- ------------ r--- ----- -- ._---.-_--' ------—------------------ f I hereby certify that I have prepared this application a`nd That the work will-6---e done in accordance with San Joaquin County ordinances, State laws and rules and regulations of the San Joaquin Local Health District. (Signed)-------------- --- r and/or Contracfor)— YB - ----- (Title)---------- -- ..... r at plan, showing size of lot, location of syst m in rely ion to wells, buildings, etc., can be placed on reverse side). " FOR DEPARTMENT,USE ONLY APPLICATION:ACCEPTED BY---_ -------------- ------ DATE....--- - - - ---•--------- REVIEWED BY-------------------- --------- ------............- ------------------------ DATE_--- - ---------- - --- ------- ------------ ------ --- --- BUILDING PERMIT ISSUED " `------- - ^' - - - -------------------- DATE----------- ----------------------------------------------- ----------and/or recommendations:_.._....__._...._.-._-._. '_y�.--. \ - -•---------•------ __- - ---- --------------- --- ---------------- •----- ---------!�--------- --------------------------- ----- -- --- ......------..........----- ------ ---•---------------------•- -------- -- ............... -- ---- ---- = ------------ . FINAL INSPECTION BY: r ------ Date--- -- ------------------------ --------------------------------- SAN --------------- ----- SAN JOAQUIN.LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street x - 205 west 9th Street Stockton California Lodi, California � ..;Manteca,California Tracy,California ?a.` EA92M 1-67 Vanguard Press _ ,�;., - , k