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3zaa �� i -� `� Permit No. ---1--`-'----z--z- �� ,., APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued __ °_`�- -•\ i�. This Permit Expires 1 Year From Date Issued A lice+ion is hereby made to!`the San Joaquin Local Health Dice strriic 5ffoq a permit to construct and install the work herein described. This This a lication is made m compliance with County Ord e A—'&, & JOB ADDRESS AN�ATIO .I Phone_.---•-----------------------------• Owner's Name-------------- - - -------------•---•-••-•- --- -- ��! � ---- ----- � � Address-----------•-------��--�1-Q••- � ,/ _ Phone. ---- �-� Contractor's Name_____-___,L�!- = Other ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Installation will serve: Residence AP Q / _-'_________ ________ Number of living units: Number Number of bedrooms _- Number of baths ___ Lot size _.______" " I!. Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table __�ft. Adobe Hardpan ❑ Character of soil to a depth ofN3 feet: Sand ❑ Gravel C] Sandy Loam [I Clay Loam ❑ Clay New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ Previous Application Made: Yes ❑ Na f TYPE OF INSTALLATION AND SPECT I TIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material__._ """_____""_ ptic n Distance ,'from nearest well-----------------Distance from foldation............ Capacity� � Size------•------- Liquid depth P Y o Pi Id: Distance from nearest well--- .DA/t Distance from foundation__-" __"--Distance to nearest lot line__-----.---- Na. of compartments-------------------------- 's I � Length of each line-____ Width of trench____- =-ylf� - g r; u of lines------ Total length----- "jlQ:-f Tu ebof 'filter ma}er3a4__--- G_16--__Depth of filter material_._. --� 11 �. i• r� � SXePage Pit: Distance,;to nearest welL._�11�-�� -Dis+once rom foundation_�C�=--:--=----.De toQeeP+hs}�e_______________Numberof pits---.--/--------------Lining matena!_ __. -_G --Size: Diameter._._ ing Distanc�' from nearest well_.___...____ Distance from foundation-------------- Liquid Caeacit gals.ol: -- Capacity ------- ---------�---- ❑ Size: Diameter ----------Depth G I'i Distance from nearest building----------------------------------- Privy: Distance from nearest well------------------------------------------------ -----•-------------------- -------------------------- Distance to nearest lot line.- ------- , ' Remodeling and/or repairing (describe ------- --------------- ------- - _ --- -- ---- "------- ---------� ' ---- . f ------------- -------- will I hereby certify that I'have prepared to+ions Applicat, n and that San JoaquinfiL calkHeal heDistrict� accordance with San Joaquin County ordinances, State laws, rul and r w and/or Contractor) d ♦ =mrelafion _ __ - -_ _. __ Si ned x ( 9 1 (Tale]--- - - - - By:---------------------------- •"-cat s, etc., can be placed on reverse side]. (Piot plan, showing size of;lat, location of so wells, bui g �I FOR DEPARTMENT USE ONLY r --Iv---------------------------- DATE----- - BY - z - APPLICATION ACCEPTED -------- ' ` --•--• DATE------------- REVIEWED BY------------------- --- ---- ----------------•----- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------- -----••-----------•--------•-------------------------------------- ---•------------------------------------ Alterations and/or recommendations:--------------------------- --- - .---------------- ----------------------------------- ---- ----- ---------------------- ------------------------------------....... A -- R- - ----------------- Ci -----------------------------•----- Date----- 9 ------------ FINAL INSPECTION BY:. •- .►_.. -------=----�-----"- SAN JOAQUIN LOCAL HEALTH DISTRICT 914 North "G" street 132 Sycamore Street 30D Wt Oak Street Tracy, California 130 South American Street Manteca, California Stockton, California Lodi, California ES-9-2M Revised 6-'59 F.P.Co. i ,