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FOR OFFICE USE: ----- ------------------------------------------ -------- APPLICATION FOR SANITATION PERMIT Permit No. ..��_____ ___._ - (Complete in Duplicate) /�/, // - _---------------°----___.;__.__ ____..__.___.______..__ This Permit Expires 1 Year From Date Issued Date issued -___ ___ z`!-_�__- 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 compliant with (;o my Ordinance No. 549Y , , led, JOB ADDRESS AN'D�YLOCATION.....(Z ------P-�-----------` �....... � t�.-.. i 'v -lc-l:[C ------!�i'S_) Ownei's Name n --------- ------------------ ------------------------ �- 5..� Phone �70 Address......................... = z'=------- -=-�• f..... ----=_------`----------------V Y ----------•----_----.-...--•-----------••----•------------------- Contractor's Name--•--=-•T--' �--'-i ► _1 -1-`5 --------- ----4a-_oma-_eJ= -----------p po__!;--- • ----------.. Phone-_404'9 Installation will serve: 'Residence ( 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel C] Other J-]Number of living units: __)----- Number of bedrooms __�_ Number of baths 1 __ Lot+size ______-� __ � ___________.__-_______-.-- Water Supply: Publicsystem ElCommunity system ElPrivate Depth to Water Table 1/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------- No New Construction: Yes ❑ No tX FHA/VA-. Yes ❑ No;' ---TYPE+OF1NSTALLATION-AND SPECIFICATIONS: -r-- (No -(No septic tank or cesspool permitted if public sewer is available within 200 feet.) - ! Septic T nk: Distance from nearest well--��- ____ Distance from foundation_______ _______Mat �Mat P115T1Nq f AtA of No, of comp ----- --25-x-----------Liquid depth._._-___"�- ----------Capacity.-,4�d.it L Disposal Field: Distance from nearest well_ -_ Distance from foundation------lQ-.--.___.Distance to nearest lot line-___a._______ `® a:XI4IN� Number of lines__--_____a__ __._._.________Length of each line__________-7S-_f-__.---.Width of trench----------- — -- ._________ . 7gdcl _ Type of filter material-___. - _Depth of filter material--------- _______Total length-----------------------7-47_)_._-__ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------- ------ El ---_❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Dept h----------------_---------------. N i Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.__.._-_______.__.__.___i----------- ❑ Size: Diameter------------------------------------- Depth--------------------------------------------------.-Liquid Capacity----------------------------gals. .� e Privy: Distancefromnearest weEL_.._____________________ ____ --------------Distance from 'nearest building------------------------------------------- Distance _________________________ .__ __.__.Distance to nearest loft line---------------------------------------------------------------------------------------------------------------------------------------------- Remodelin and/or repairing describe :__.______ __ ..___`4 G ,SYS / ---- --------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------------------- 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. _. .(Signed)_. _ C "�+ = _ Owner and/or Contractor) B = ----: ��'`�` --------------------------------------- (Ti+le)---- - ----------------------------------- y + (Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side). r . ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------- ---------- DATE------------------------------------------------------------ l REVIEWEDBY--------------------------------------------- ------------------------------------- -- DATE-----f{ - - ------------------------------ BUILDING PERMIT ISSUED--------------------------------------------------- �------------- --- ---------_. . DATE---------- ------7-------------------- ---------------------- Alterations and/or recommgndati ns: - ----------- - - - ------------------------------------ ----- - g� { - r ° ," ------- -,it--- ------ ---= ---------------------------------- [lWl" FINAL INSPECTION BY: Dafie _ _ _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-S9 3M 3-'63 F.P.CD.