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FOR OFFICE USE: ------------ ----------------------------- ------------- APPLICATION FOR `SANITATION PERMIT Permit No. -- - ---------------------------- --------------- (Complete in Duplicate) Date Issued _ _ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a perm• to construct and install the work erein described. This application is made in compliance with County Ordinan No. 59,.1 AND LOCATION--- - - --[ � L- *-- JOB ADDRESSr f n Owner's Name ------ ------------ Phone �b_= o� _.t5.� --- ------•-------------------- Address----------'��_�._'---------- --- -- �+--�i -,"`-=`--�`-4'-��cr•��---��- , - --- -----------•--- Contractor's Name---- Installation --- _ _ 1�._ 2--i---l._e___._ ?. G-.--'c'----------------- Phonetb�a.'" C?. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ___.___ Number of bedrooms _k Number of ths�____ Lot size' _ �..,------��-- - Water Supply: Publics stem Community system ❑ Private Depth to Water Table 'r ft.� Y ❑ Y Y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: [If yes,da e--'��...............l No ❑ New Construction: Yes ❑ No �A/VA: Yes ❑ No ❑ y,} TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) + ! ' Se Distance-from nearest-well-----------------Distance from foundation________________ _.Mate:•lel--__-______....________________..___.__.__.._- �d , . � ,,fid , No. of compartments Size Liquid depth Capacity f osal, :� Distarice from nearest well.l �.--.-Distance from foundation___. _. Distance to nearest lot line_ 1 :. '' re s,, . ,, Number of lines ___.____ � �_____ Length of each line----/__� ___________ Width of trench___ 'rf.C--. _.._______R______ _ _ Depth of filter material--------f_ -- _ gth------------------I�------.----- r,(r � � x -Type of filter materia: � p �-`-�-Total len Seepa e Pit: /� � foundation-----/--5' ,- - ------i 0 Distance to nearest well._. ___ �_ __Distance from __.Distance to nearest lot line b ? Number of pits__1_________________Lining material___i�Q.C.._ -Size: Diameter_ .._._____Depth_... �.T- �. . y Cesspool: Distance from nearest well-----------------Distance from foundation----------------_ m;ng material--------------------.- __._______-_, ❑ Size: Diameter------- ---- ----------------DePW..---- ------ y----- ----------------------Liquid Capacity----------------------------gals. , Privy: Distance from nearest well------------ __Distance from nearest building---------------------------------------- -----------------=- ------ ❑ Distance to nearest lot line---------------------------------- ---------------I-------------------------------------------------------------------•---------------------- Remodel --------------- t Remodeling nd/or repairing (describe):----------- --- ----- Y ------------ -----' - o . t ------- ----------------- -- --------------- -------- - ----- ------ - --------------- --------•-------------------------------------------------------------------------- ---- -- V� I hereby c of that I have repared thi p lication and that the w k will be a in accordance with San Joaquin County ordinances, Stat . law and rule and regul sof the San Joaquin a strict. iA ----------------- ontractor) (Signed)__ -, - --- -- -- --------- ------ - - - -- ---r---- - -ft�--�� F B1 � -- ---- -----(Title)------------------ ------------- ------- -------- -------------- y-----------------------*------ ----------------------- v (Plot plan, showing size of-loit, location of system in Tela on to wells, buildi s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY } APPLICATIONACCEPTED BY---- ----.-- -�" �--------------------- ---------------------- ... &---BY------------------------------- ----------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED - DATE-- ------ ------------- f Alterations and/or recommen[[7[�1{ations:___�.s_..---_Sp__ ..__.__.� .--1 Y1. -�. . =e # `----- -z'- -^ � Q.• -- I AA }� -- + -------------------------�-�---------- ____-------�V--__1 �6 � _.____. ---------------------.----------------.---------------------------------._....- -_- --_ ._.____.______________-.._.__.__________________ ---}_________...___________________----_- -----__-__________._____..___._-_._ ------------_-----------___---------_-------------------------------__------_---------------------_------_----------------------------_------------------------------------------_-------------------------- FINALINSPECTION BY:..--- t---*-.. ------------------- ---------- Date-----a)'---G1'-,(1--s------------------------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California• `Manteca,California Tracy,California r.c.a❑.