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FQR OFFICE USE: -- ' - ---------------------- ----------------- ---- --- - - ----------- . APPLICATION FOR SANITATION PERMIT Permit No. . ............. -----4 (Complete in Duplicate} This Permit Expires 1 Year From Date Issued Date Issued .- _-- ----_� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with o t rdin No 59 % � � . JOB ADDRESS AND LOCATION. - = ---- `'' -------------------- ----------- Phone-- . Owner's Name------ - � -- - ----------- -- -- - --- ------------------�----y - - - - - - p -------------------------- ------•------------- ---------------------- Address-----4. -q ti.. . Contractor's Name------ - ------•---------------- ------------------------- ---- ----- ----------------------- ----------------- Phone..---- ---•-------••--•----- Installation will serve: Resident P[ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -- ----- Number of bedrooms--- Number of baths--1---- Lot size l -Q' t- -c� --------------- Water Supply: Public system ❑ Community system [I Private ® Depth to Water Table 4-0 ft Character of soil to a depth of 3 feet- Sand E] Gravel E] Sandy/ -Loam g Clay Loam ❑ Clay ❑ Adobe []._.Hardpan ❑ Previous Application Made: llf yes,date_----\__ -- ) No New Construction: Yes No ❑ FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public Iewer is available within 200 feet.) C p ' LLQ Septis/Tank: Distance from nearest well-----------------Distance from foundation--.-._--.__---___.Material....-.... 1'-. --- No. of compartments-- �"------- Siz ef9_S:xZ..---------LiquidCapacity depth------ - �--- ------- -- -- --- - �. Dispos Field: Distance from nearest well._ f1..�.-Distance from foundation----fir- - -r---.Distance to nearest lot line-----'S.--.---.. Number of lines --._ -Z,---- ------------------Length of each line-- Width 7r------ of trench-_42 �/;;- ----------------- Type of filter material- -� _-.-.---Depth of filter material....4�'---------- length--/ - --_---------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance tonearestlot line----------------- ❑ Number of pits... ................--Lining material----------.- Size' : --- Diameter ---------------- -- Depth � Cesspool: Distance from nearest well ----------------Distance from foundation-- ------- ..Lining material--,----------------------------------- t ❑ Size: Diameter- -- ----------- - - -- -----------Depth------------------------ - ------ ------------------Liquid Capacity, .- - ----- -------gals. { Privy: Distance from nearest well----------------------------------- .----Distance from nearest building.----------------------------------------- I ❑ Distance to nearest lot line --------- --- ------- ---------------------•------------------------------------------------------------------------ IRemodeling and/or repairing (describe):----- ----------- ---- ---------------------------------------- -------------------------------------------------------------------------------------- ------------------------------------- - - - ------------ - -------------------- - 12JQ 1 ; T I hereby certify that I have prepared this application and that the'work'will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. a C !'� - — - = - ---------- -------; ....'[Owe and/o ontractor) "' {Signe �- ----- - ----------- * ' nr �C Title '. (Plot plan, showing size of lot, location of sysfem in relation to wells, buildings, etc., can be placed on reverse side). . • 1 � ! FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED`BY- DATES-_-- -- - --- ------------------- --- REVIEWED BY - = DATE --------------------------- BUILDING PERMIT ISSUED-------- -- -------- -----------------A� ---------------- ------------- ------------------ DATE---� Alterations and/or recommendations:............1larf�.%..04A -�------YN.----.--[1� --- 15PR�- S--.--- 1�-�-vitE j --W KRI.S....940 r.=--=- ---1450 _ - ------ ---------------------- ----------- ---- - ¢------------. ------------- --- -• . ---------- ----------------- .. ;R ------------- -------- FINAL INSPECT49la1—�1(! Date-.-..-/- - -------------- _---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT > � 1601 E.Haz*lton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi, California _ Manteca,California Tracy,California E.H.9 2M 1-67 Van9V9Td Press