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APPLICATION FOR SANITATION PERMIT Permit No, l i �7 Z•9 (Complete in Duplicate) Date Issued �7/�_7- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicafiorr is made hi'compliance with County Ordinance No. 549. JOB ADDRESS AND I S CAT N. r ---------------------------- Owner's Name _ -------•----------------------- •------------ -------------------- ress-_.___ t ------ Phone_ II�. ------------- -------------------- Name--•---•--------- ------ --------------------------------------- ----------- Installation will serve: Residence 7�1'S.< --`-- Phone^ �/ rt ❑ Mofef Apartmenfi House ❑ Commercial [] Trailer Court Number of living units: - ❑ Other ❑ . g II -- Number of bedrooms --2_ Number of baths _-- Lof size ----- - - r Wafer Supply: Public s ste - �---��-�-T�-------�----------•-.. pp Y' Y [�Communify system ❑ Private ❑ 'Depth to Water Table --�s ft: Character of soil to a deptli�of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ No Previous Application Made:l Yes [[Hardpan ❑ [�-New Construction; Yes ❑ No ®/FHA/VA: Yes ❑ No (]� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or`ceysspool permitted if public sewer is available within 200 feet.) e iG k:, is from nearest well-----------------Distance from foundation_--- _____-------- No. of compartments--- --- Material--------------------------------------- --------- D' I depth-------------------------Capacity.--•------------------ D' ' qal Fi Jd: Distance from nearest well---------- ------Distance from.foundation.-_----,__.-___-- __-Distance to nearest lot line----------------- Number of lines----------------- ---------------Length,of-each line-------------------_-__ Width of trench._--_.--_--,_____ --- p 9 Type of filter mate"r�ial-I-----------______ ---Depth of filter material-----------------Yp 4 See a it: Disfance �o nearest well-. Total length------•----------------------------------• t / --Distance4rom undation---- dJ= Distarce to nearest lot line--- G____._ Number of pits--------l-----------Lining maferial-- - - dr -Size: [Diameter--- .c. -._ -----Depths Cesspool: Distance Irom nearest well-----------------Distance from foundation--�__� ' ❑ Size: Diameter Lining material d� -----------------------Depth-------------------------- -------- ----------------- Capacity...- ..gals. 11 Privy: Distance from nearest 'Well---- -_ k "� - ---------------- Disfance from nearest buildin ❑ Distance t�o nearest lot line------ ---°:--- - - , g------------------------------------------ �l •--------------------------------- ------------- Remodelin and/or repairing` (describe):---_�-��[_ ��---��±>�Y,�---�Y---�-r, i-t��•r-_�- ----- 11 ------------------•----•------------------•---------- -------------- + I hereby certify that I ha'L prepared this application and that the work will be done -- accordance with San Joaquin County ordinances, State I s, nd runes a d regulations of the San Joaquin Local Health District. Si ned K..� { 9 )-----•--------------- - - -- By: {Y : - ^ --------------------------------- caner and/or Contractor) i ------------------- ------------- ------- � __ __ (Plot plan, showing.size of lot, location of stem in lation ts, buildings, e (Title)__-_- g , tc., can be placed on reverse side), I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYLl_____________________' ..... REVIEWED BY--------------- d� -- ---'------ DATE__- '.. BUILDING PERMIT ISSUED-- dr --- ------------------------------------------•---------------------- DATE- - --- ------------------------------------- �r ----- DATE.-------- Alterations and/or recommendations-----------------______.__ -----------------._._- ------------------------ r ----------------------------- -------------------------------------- ---------•---------------- •------ ----- --- ----------- ---- - -- __ _ = v -© ----------------------- ----- --------- t--------------------- ----- ------------=--- ------------------------------•------------------11 ------- ---------- ----- -- FINAL INSPECTION BY:----- MM -___- y� � S ---- - '� a e 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 1-57 F.P CiI. �.i