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y�0, APPLICATION FOR' SANITATION PERMIT Permit too. F 7 7 Coni fete in Duplicate). � ` �- " - lt%c, ( pt p ). ` b Date Issued rnff,�,j` �, , ` Application,is hereby'rriade to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is trade in compliance with County Ordinance No. 549. 't -y-- �4 -�' � u/--`-- ----- - --- - •--y i JOB-ADDRESS, D LbCATION----�-' --� � � - ---�' - � -- --- (� l r k r' 'Name_ ✓ �.& -, Phone. Address I - - �� caner s -- ------------------------ ------ - ------ - Contractors Name_____-_ ____ , Installation will serve: I Residence N Apartment House [-❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.L__ Number of bedrooms ---I_ Number of baths ____(___ Lot size _ ____; ____fi "_ __.__-_________ Water Supply: Public'sysfem'w—Comnniu'n•ity"systern'❑Private"❑"'D'epth to WaferlTable 3--s-ft. Character of soil to a 1epth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [) Clay Loam ❑ Clay ❑ Adobe Hardpan ❑, ;A Previous Application Made: Yes ❑ No [M New Construction: Yes LE No ❑ FHA/VA: Yes ❑ ,., N.o TYPE OF INSTALLATION AND SPECIFICATIONS: + (No septic tank-or cesspool permitted if public sewer is available within 200 feet.) r h Se ,e-Tank: Distance from nearest well_________________Distance from foundation--------------------Material:. ___.______.'___-_________________..__.:--: No. of compartments-------------------------Size--------------------------------Liquid depth----------------- --,-Capacity------- ------ Disposal Field: Di tance from nearest well_________________Distance from foundation----------- -___---Distance`to nearest lot line____:_-_-_____- f ❑ Number of lines-------------------- --------------Length of each line I--------------_-------------Width of trench--------:-- =-------- 1` 'TypeP aterial----•--------- -------Total length---------------M---------------------- t, Ir" - - - # Seepage Pit: Distance to nearest well-------------_-----_-Distance fr m foundation_ ___ istance to nearest lot,line__�Z � 0 o iter materia_ _______________________;-Depth o iter m Ell Number of its.__.__-__l__--_--_--Linin material--___ e ,- Size: Qiame er___ -, - .- p Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material--------*_-______'---- ----------- Size: Diameter------------------ -------- ----------Depth ---------------------`------------- - -- -------Liquid Ca acit igals. Distance from nearest well-----------__-------------------------------------Distance from nearest ---------- F1 -__,_- Distance to nearest lot line______________ I --------------------- z------------------ - Remodeling and/or repairing (describe):_ _____ _ . ,2 �____ ---------------------------- 10 . r� // ------------------A4'-p'------------------------------------------------------------------------------- �i! 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 rules and regulations of the„San Joaquin Local Health District. (Signed) _"-'• -- '!*C-.-.- --:-=`.--- =: --_b-- Owner a% or Contractor Y• &;ng ?, 7;_ __o__fP74ySM_,1 �lYi .---- - - �iiie} ./[Plot plan, Eze Z relati n to wells, buildings, etc.,'can�be placed n reverse sid Nk,� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ------- ---- ---------------------------------------------------- DATE------- g (--------------------- REVIEWED ---------------- REVIEWED BY--------------------------------------- - - --- -- ------- ---------------------------------------------------------- DATE-----=I- --------- BUILDING PERMIT ISSUED__..---.__•------------- DATE--------}--------_--------_-_.�' ` --------=------------------- Alterations and/or recommendations:----------------- ------------------ ---------- -----------------------------------------------------------t--------------------- ---------------- _..___.._ __.__ _ .y_ _ _r-tic.z...-.-��..�-a._s_c_________________4TH-"�•�'� ," ! �� --------- --------------------------- ---------------------- ---------- - ---------------------------------I---------------- = •Tn - C _ --- ------------------- - - - ----------------- -- --- a --------------------------------------------------- -------------------------------�"f--- :� 1-.-7 ---------------------------- r, FINAL INSPECTION BY:. -- Date.------. ; -- ------------------------- ' 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 Revisea 1-57 F.P.CO.