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i FOR OFFICE USE: -----------:---------------I------------------ APPLICATION FOR SANITATION PERMIT Permit No. ._.,f_ �&_ . ..-._[------ - ---- ---- " "----- (Complete in Duplicate) _ - AA-�---- Date"Issued . --------- -- This Permit Expires 1 Year From Date Issued - - -- -------- ,Replication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No. 549. �Jr1 4dJ OB ADDRESS ANDjLOCATION--y"'a.--.- A _- ------- - ,Owner's Name-,-- •------------- ---------------- ----- .......................... Phone-•---•------- I I Address --------- -- ` ----- -----{--------• ------------ ------------- -- {�-'`} -�------ ------- Contractor's Name a i " = Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- _ Number of bedrooms - Number aths ----__-- Lot size _"-"- - _ -_-- Water Supply: Public°system ❑ Community system ❑ Private Depth to Water Table -------_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay L.oam� Clay Adobe ❑ Hardpan ❑ I -� Previous Application Made: (If yes,date--------------------1 ,No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: ( septic tank or cesspool permitted if public sewer is available within 200 feet.) r i ,l Septi ank: Distance from nearest well_-mP.-.- -.Distance rom foundation--.--�_p_'-----.Material---- I C <. QQr � . r No. of compartments------------------------_Size_ X_ - rJTLiquid depth----- ------___----------Capacity " - Dis os Field: Distance from nearest well____.✓e_._.Di.stance--from..foundation----1Q---......Distance to nearest lottine- Number of line ----------- Len th of each line - p ,��_ g 577 .--W—;V Width of trench--�------- f W Type.of filter material---''`-" i----Depth of.filter material------/-?i.""--.Total length"_ - ------------------ " Seep e Pit: Distance to nearest well---JQ_'tJ---------Distance fr undation-----fid-___-_--.Distant Distance nearest lot lin;. '--.-__.- (� Linin material _ -Size: 'Diameter___"_ _. De th Number of pits g ----� - p r-------------------- Cesspool: Distance from nearest well ;------------Distance from foundation__________________".Lining material------------------------------------- ❑ Size: Diameter------ ----------------------------- -Depth----------------------------- ----------------------Liquid Capacity- - ------------------------gals. Privy: _ Distance from nearest well------------ --------------------------------Distance-frorn nearest-b-uildipg-_-------.---------------------- �,,.----. q r/ ❑ Distance to nearest lot line------------------------ -------------------- ----------------------- ..------------------------------------------------------.---------- 7 T t =--------------------------------5 a ;r Remodeling and/or repairing (describe}---------- ------------ ------ ----- - -------- -- ------ i t >'" I t'... ------------------•--•-----------------------�'-`- = -- ------------------------------------ . --------------------------------------- + .- -------------- ------------- r I I herebySlael e prepared this appii and-that the work will be done in accordance with San Joaquin County ordinances, Ses and regul Ions of the n Joaquin Local Health District'� ran r Contractor) Si ned � � f�- - 9 )--------B `� � -------------------------- - - Title) ------------- ---- ---- - ---Iplan, shlocation of system in r latto o wells, buildings, etc.; can be placed on reverse side). FOR DEPARTMENT USE ONLY ' t � i APPLICATION ACCEPTEDiiY 2 r -------------------------------------------�-------- DATE----- •T---r' -------•---------------------- REVIEWEDBY--------------------------------------------------- ---------------------=----------- ------------------------------Y--------- DATE-------------------------------------------=--------------- BUILDINGPERMIT ISSUED---------------------------------- ----------- --------------------------------------------- I----- - DATE------------------------------------------------------------- Alterations and/or recommendations:-------- ............ -------------------------------------------------------------------------------------------------- -- --------------•-------------------� --- ---- �-•---------------------------------•------------------------- :-r* '-� - ,4 ----------------------•------------------------------ ------------------- ----------- -------------•--------------------------------------------------- -----------------------------------------------------------I-------- I ------------------------------------------- -------•- ---------------------------------- ------------- F - FINAL INSPECTION BYDate------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 65 9 REVISED 8-$9 3M 3•'63 F.P.r.D.