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APPLICATION FOR SANITATION PERMIT Permit No. .J�_ '........ (Complete in Duprcafel Date Issued AOA4� This Permit Expires l Year From Date Issued Application is hereby made E, the San Joaquin Local Health District for a perm-t to construct and install the work herein described. This application is made in compliance with County Ord- nce No. 49. JOBrADDRESS AN CA'TION---------..A. � _ .. --••------- Owner s Namc.-.-...... f,-i -._.......-. - --�'-� ------ -"I Phone..................-....... ii r� - Address--------•..............•} v.s i - k �. � - t`- �� ---......-----••----- - Contractor's Name-.:.......-. .{�......... Phone - ih Installation will serve: Residencec&L Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0,her�❑ Number of living unitl� -.. .__ Number of bedrooms __ Number of'baths _A... Lot size ____ �-�-`A"��a = Water Supply: Public syst I ❑ Community-system ❑ Private Depth to Wates Table _:. - - ffi. Character of soil to a depflrllof 3 feet: Sand ❑ Gravel 0 Sandy Loam❑ Clay Loam ❑ Clay❑ Adabe�Hardpan❑ Previous Application Made:' Yes ❑ No [; New Construction: Yesy( No ❑ c FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septi nk or cesspool permitted if public-sewer is available within 200 fe } - - pp si..j S p rk � �stanca� from nearest well::._- .Dista n a rfro �oun fpn....................Mat vial:--. •••• �- � + � -..-.....__Capacity . No. of-- mpartments �. Size--- ----- - ..... .Liquid dept#h --..-..- -- .`.. .rte .............-.-.. Dispa al ielci:, Dlstanc�,�from nearest well - ..-.Distance from foundati f.- .19--_-Distance to nearest lot line----I ........ Number"hof lines._.....: - _r Length of each line________..[`:�r�.._....-.Wid+h of trench-. -,. ... 1 ------- �' _Type oflfilter material. w1vi�a�pth of filter material--- g-___---------Total length___-4-• --:................--_-.--- ,r .Seepage Pit: DisfanJ to neares+ well-------- Distance from foundation____-_._...........Distance to nearest lot line._._..--._-____-. ❑ Number of pits ---------------Lining material--------...............Size: Diameter------..................Depth--- --------------............ -►3 • I Cesspool: Distant from nearest well......-..........Distance from foundation___- -----------Lining material ❑❑ ° - � material__________________________--_ 9Size: D"�me#er---------------- --------•--....Depth_---- •-----._....---- -...._..------- -• Li Liquid Capacity Privy'•.i-+ -nistaril from nearest well ----------_........._--------------------------Distance from neares+ building---------------_------------- .--_-_ a-_-_l-_s-_._. Distaril to nearest lot line------- ------`----- --------------------------------------- -----------•-------------•----------- ---- Remodeling and/or repairi�IP:g {describe):-------------- .----------• ----------------••---•--------- -------------...-....-- dr -.. - - ------- - -. I ----------------- --------- -------�; !l_.._..._.............._-- ---- ----------.------------------------ i ----......_._-.--••-----••-------- ---------------------------------------------------------------....._.--------•----- - -----------------•-•...................... -- hereby.certify that (have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I rules and.regulations of the San Joaquin Local Health District. �( F ---_-._(Owner and/or Contractor) BY:---------------•----------� .........--------- ---------•-• ...1. -------- ------------..- •- .... {7itlel -------- ----- (Plot plan, showing size of Itt, location of system in relation to wells, buildings, efc., can be placed on reverse side). c _ FOR DEPARTMENT USE ONLY APPLICATION .11ACCEPTEI BY_ - DATE 1--• ---------- REVIEWED BY-------- _ BUILDING PERMIT ISSUED. :...-. .. -----.:........... ....— ---- Df4TE - ... Alterations and/or mrn ndations:i..... - - -------------- - ------------ --_......-------------------. ----------------------------------- _.__................ - ._._...__... .-.._.__.._.-... ... - .- ------------ -- -- ......... I - ----- ��, Ldr.7 li. ...- ?. - -- 7 ............ . ,ll' ~ --- -- - ------- ------ -------------- - r _- � ' FINAL INSPECTION BY;: Date............ ...... ;II SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Arnorican Straet 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, CaliforniaI Lodi, CaPfornia Manteca, Califomia Tracy, California :II. - .I ES -2M Revised 6-59 r.PZ. .