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FOR OFFICE USE; ------------------------------ ------------------ APPLICATION-FOP --------------------- SANITATION PERMIT Permit No. - - (Complete in Duplicate) Date Issued 0� ---------------- ----------------------.------------- This Permit Expires i Year From Date Issued Application is hereby made to the.San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �, JOB ADDRESS AND LOCATION ' ._. f J.. - Com/ �r.�tr-�� -------------------- Owner's Name----------- --------------------� --------------------- ------ Phone/;I'D =3----------- --- Address -- Address------ ---- ----. -I ------------------------------------------------------------------------------------------------------------------•---------------------------•-------- Contractor's Name f -- ------ -----. Phone _� 1 _= ` T Installation will serve: Residence Ei"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ,.Number of living units: Number of bedrooms -I....Number of baths ./--- Lot size ____________________ Water Supply:. Public system [I'Community 'system ❑ Private 5:j epth to Water Table X70 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑s Sandy.Loam ❑ Clay Loam 0 .Clay E] Adobe�ardpan E] Previous Application Made: (If yes,date--------------------f No Pf New Construction: Yes ka---No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Tank: Distance from-nearest well T �--Distance from foundation_-IA?--------- SepticMaterial�� - ------------------------------------ No. of com artments_..__..___'7-.�----------Size_ _ -- ®� p --- - - -- Liquid depth----- ---------Capacity,pr•11" _ , Disposal field: Distance from nearest well...�P---- Distance from f urdation._._ �_-------Distance to nearest lot line___`;______' y� umber of line's----------IV Length of each �_- fl Ine-- -- a ---.Width of trench-------�-----------------•-- `/, type of'filter .material________------------------Depth of..filter material---:. _c�_�g��_;Total length-----��-__f_�.______.__.__.___._ Seepage Pit: Distance to nearest well-_--_--_-_ _. :Distance from foundati n_� _. Distance to nearest lot line------______--._ ,r f -„ ,r f p Number of Its p 1. r izE:lDiameter Depth -- T.. ,e e�4 • _ --- ----'S Cess❑ool: Distance f" m.nearest well- __.__g--__Distance from foundation--------- _----- Lining material____..-_------------._-__--.-- -_._- _ _ _ Inln materia____ ❑ Size: Diameter --------- ---- ------Depth -- 'T ;-* '-- _Liquid Capacity----------------------------gals. Priv . r - Distance from.nearest well---------------- )------------------- gest building ❑' Distance to nearestaot line...___.__---_- -------------------- r ____ -- D.istance from nearest ------------------------- ---------- and/or repairing (descrlbe):--- A -----i--- - --------------------------------------------- 'Remodeling --- 1 M 1 I hereby certify that i`haveprepared this application and that the work will be done in accordance with San Joaquin County F ordinances, State law ,_and rules n - regu ns o Joaquin Local Health District. (Signed}--e-- _ -P__ _ ---- --- 1.. (Owner and/or Contractor) By:--------------- = ---•--------------------------------------------------------------------------------------(Title)- ------ .....---..-------------- (Plot plan, showing size.of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ------------------------------------------------ DATE------- - � d E-2� REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE--------------- -------------------------------------------- BUILDING PERMIT ISSUED-------- ' - f -•-- -----=------;- ----'--_e--`------------- ------`--_-- ----------- -------------- DATE--------------------- ----------------------- -G-----am----- Alterations and/or recommendations-------- . . =--- --- y --------------------------------- -------------------- _!7 -- -- r _ - — �_!� ----- ------(� ,-------------------------------------------------- < �¢-Tc -� -^=dti� �----- - ----------------- --------- -- ------------ csv�, - -------- ;� FINAL INSPECTION' BY; --------- ..._� / ---_' Date --------------`-------- ------------------------- Ip _y;5;41 0 UIN.LOC�-'HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street c Stockton,Gallfofnia Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 3M 3-'63 F.F.CO.