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APPLICATION FOR SANITATION PERMIT Permit No. ----- ..___ (Complete in Duplicate) Date Issued �s/---� A plication 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. 49. JOB ADDRESS AND LOC ION Z'2 r. 1 ---------------- "�� ;� �'. r �� Owner's Name__________ ------ , 0D-Zr-40-6-1) -0-t-)----- ----AAddress---------_--------- ddress------•--_--------- 2------ -F--__ 12 — 1 ---- ----•- -------� ``---- Contractor's Name_ ��.,, --------- ----- Phone_ __ _7Q, Apartment House ❑ Commercial ❑ Trailer Court E] Motel F] Other ❑ � r s InstallaNumber of lion will eving units:nl ---fNumber of bedrooms __-Y Number of baths __/-- Lot size -_.___._ ____ _.___12 ------------- Water Supply: Public system `[Community system ❑ Private ❑ Depth to Water Table 4Tft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [B-"Hardpan ❑ Previous Application Made: Yes ❑ No © New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ! TYPE OF INSTALLATION AND SPECIFICATIONS: �✓ — , (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Sis Tank: Distance from nearest well________________Distance from foundation--------------.----Material :__. ----------------------- y .a! No. of compartments--------------------------Size--------------------------------Liquid deijh--------------------------Capacity---------------------- Dis Distance from nearest well-----------------Distance from foundation-------------------_Distance to nearest lot line--------•________ Number of lines-------------------- ------Length of each line-----------------------------.Width of trench----------------------------- Type of filter material_________ _____-____. __Depth of filter material--_.---_.__-__._____._Total length------------------------------------------ P.f P't: Distance to nearest well_ __Distance om foundation____«:.___.Distance to nearest lo# line_-___ -- Number of pits------ -------------Lining material_. _------Size: Diameter-- -, -�� Depth--e _-` - ------___-.- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material--------------------------------- T-1 _---_._____---..--._____-----___❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. . Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ (Al ❑ Distance to nearest lot line--------- ------------------------------------------------------------------------------------------ •--------------------------------------- Remodeling and/or repairing (describe)---- ----------•------------------------------------------------------------------------------•-- ---------------------_-------------------------------- ------------------------------ -------------------------------------------------------------------------------------------•------------------ -------------------------------------------------------------------------------------------------------------- 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, and rulIDAYand&re_NIGHT of the San Joaquin Local Health District. (Signed)----- 0--oo Septic Tanlc Service �� Contractor] T2 6 So.Eldorado HO 2-7046 -JBy:.-- -------------------S4A��t��,_r 4.1_•---------------------------- -- ---- AV '��Title)------------------------------------•--------- ----.------------ (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc.q n be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- DATE._.. 1 REVIEWED BY---------------------------------- -- DATE. 7------- BUILDING PERMIT ISSUED ------------- DATE ------------------------------ Alterations - - Alterations and/or recommendations:-- ------- -•------------------------------------------------ ' ----- . --------------------- ----------- ---------------- - - --•--------•-•-----•-•----- - ------------------------------- - V-1�'" FINAL INSPECTION BY:_ _ Date 4-4---�7- ---- -----•-------------------------- --- 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 E5-9-21x1 . Revised 1-57 F.P.CO.