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FUR OFFICE USE: , -------------------- ----------- _ APPLICATION FOR SANITATION PERMIT Permit No. ------- - -------------------- -------------- --------- (Complete-in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District fora q permit to construct and install the work herein described. This application is-made in compliance with County Ordinance No. S44: JOB Owner's N LOCATION. /n` a`� } //�� ADDRESS A �l` / K.-------1--�.l�1 ��7 - . . �=0. 1't__L.. Phone_- q.©- `S Address-----112,015 �� ,u-IE=••• - :_ - f 1 Contractor's Name__4W.tV r --_._______________________ ----- ------------------•- ----- - ------------ --- -- ---------------- Phone.---- --- ----- Installation will serve: Residence El Apartment House [ICommercial Trailer Court E:1 Motel ❑ Of ❑ Number of living units:.__ ----- Number of bedrooms _-._---- Number of ba+hs _/--__ Lot size Water Supply: •P �� p /A07- ft ublic-system'❑` Community system❑'Private e th to Water Table Character of soil to a depth of 3 feet- Sand Gravel E]I Sa dy Loam ❑ Clay Loam E] Clay E] Adobe [] Hardpan ❑ . Previous Application Made: {If yes,dote_.,.------...__. . ) No New Consfruction: Yes 0 No FHA/VA: Yes ❑ No TYPE ,OF INSTALLATION AND SPECIFICATIONS 1 IIVoseP P (N45--septic tanker cess ooI..p ermined if P_�ublicksewer T Septic I Distance from nearestiwell....._.. &__Distance from foundation-__ -167--------.Mate dal _C_4_71VCA�.��.--- ----� No. of compartments--'----------- .......-"-Size..- •• _X!!1X5---- - -- - Liquid depth____. t,--CapaacitY--- —~ Disposal Field;y Distance from nearest well--__,�- _---Dista ce from fouridation_1_0--------_Distance to nearest•lot lin 51 '=t^ e___ -- ow r G Number of lines---------- Length of each line...__..�Q- ` .._.Width of trench-. -��----- Type of filter material,-- G _---Depth of filter material... ._ . T «--- --------Tota! length---- ----'�- -`�-Q----------- Seepage •-.' { Q n Pit; � ,Distance to nearest well___��[.�-...__Distanc from foundation__.............. Distance to nearest lot ine__:�_`___ ' Number of pits--- .__ ___-__..._.-"Lining material_��_ck"l.$ize: Diamefer_t� .f"_Q---Depth.".___ ..f_ ) _ ----------- Distance from nearest well ...._ _.._ __Distance from fo ndation_________________ __Lining material---,---------------- Cesspool: i ._-._ . ------------- ❑ IV, Size: Diameter. -------- --- ---------------=Depth' ---------- - -----_ ------ ----..Liquid Capacity....-...... -------------gals. Privy: Distance from nearest well-------.-------------_--- ---------- Mstance from nearest-buildin ___.______ ❑ Distance to nearest lot line_________________r.-."--"- -- -------------------------------------------- ----------- Remodeling and/or repairing (describe):--------- -------_ .� ; ---_--•--------------------------------------------- - - ---------- - --------------------- ------------------------------------ -------------------------- ----------- ---- - = --------•- ;----`-` I hereby cer+' hat I ha prepared this application and that the work will be_done_in accordance with-San Joaquin County ordinances, St w and r esea regulations of;the San"Joaquin Local HbalthrDis+riot. 1 t (Sign ~~ ' - ---- _ ------------- -------- wrier..,- an _ r Contractor) ABY # ------- -------------- (Plot � ---- - 1 -- -(Plot - plan, showing?siz a of lot, location of system in tela+ion to wells, buildings, etc., can be placed on"reverse sidel.{ FOR DEPARTMENT USE:ONLY APPLICATION ACCEPTED BY__... �_ -_Q--__-_- ..----- _-- __ :' "6 p - ------ ; -- -- DATE. -, � -- ------------------- REVIEWED BY------- DATE_-.------------------- BUILDING PERMIT ISSUED -------------------------------------- -------------- ------------D \TE-- - ----- 0. -----wofZK - -a ---:Alterations enc/or recommendations:__..._. 0 _I_f k . - 7------------------------------------- - --- ------ ------------------ •---•------- ------------- ------ ------------------------------- ----- f ------------------------------------ --- } -- --------- - -------------•---------- FINAL INSPECT! `! _. .= - Date--------- --------------- `__ � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Moielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California E.H.92M 7-67 Vanguard Press 'F