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FOR OFFICE USE: ------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 1..---- ---------------- -------------------------------------- ___ ...... ----------------------------- ------- (Complete in Duplicate) Data Issued .1�._7-42.:-G6--- __________________________________________________________ This'Permit Expires 1 Year From 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 Counk Ordinance No. 549. JOB ADDRESS AND LOCATION_________ _____ _._ J Owners Name = --- one _. ----- Address------------------------ '.-�� d2' -•----------------•-•------------------- -------•-..................--•-------I................. Contractor's Name = ------- -------- Phone.. .......... -- --------- Installation will serve: Residence &T Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _.-- Number-of-bedrooms` v Number,.of-baths./�.1 -s'ize,___________ y y:-__.-.-_ _ -,. _ Water Supply: Public system ❑ Community system ❑ Privateepth'to}Water Table _6W___ f#. Character of soil to a depth"of 3 feet: Sand ❑ Gravel ❑ Sandy Loam.❑ Clay"Loam Clay ❑ AdoSe❑ Hardpan ❑ Previous Application Made:3 llf•yes,date---..-._,__-�_. :::I 'No le New Construction Yes_ ;. No ❑ FHA/VA- Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: + (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I, Se tic nk: Distance,from nearest well ��----D:is'tanz "�Pm fo n_y `In - ------ .'MatenaZ_ p J� dafi l,Q'i__ ___ dNo. of compartments--------- - ------------Size._. _-X!_�'q f ep! t-- -------- DisposaJField: Distance from nearest well.Ia f._.Distance,from4 foundatiotn._- -_ _-. .D' t ce #o nearest lot ne__- _�_, Number of lines-.�-W-._.. -_Length-8f'each line :�a. �, � �i h of -�______ } A----- !! i Type of filter material-�---------____- .Depth of filter maters L3jje_..4.--)....Total length--------14��------------------- 4, i1,6_ /1171 Seepage Pit: Distance to nearest well________---..____-__D,istance from foundatiors-----------t_____._.Distance to. nearest lot line----------------- �; ❑ Number of pits------------------ --Lining material________ Diameter---------.--------.._-Depth---------.-.---------------- Cesspool: Distance from nearest well-----------------Distance fro foundation.....{r y...:....1ining material-------------------.-----------------� Size:,Diameter--.-.--. De th-.--------------------------------------- L uid Ca acit -----gals. Privy: Distance from nearest well-------------------_-----------------------------Distance from nearesf building------------------------------------------ ❑ -? 4 Distance to nearest lot line--------------------------------- --------------------------------'=-----�---�--------------------------------------------------------------- Remodeling anVor repairing (describe):------ / ---- --------- --- - - - ---- --- ----------------------------------------------------- - -g /f _ � - �-- --- -___ -_.___ J -_ _ ; I hereby certify that I have prepa d 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. u Signed(. ( 9 ) - �j :}- = ------------------- ------ ----- (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.--------------------------------------------------------- REVIEWED --------------------------- _ - -- --------------------- REVIEWEDBY--------------------------------------------- -------------------------------------=--------------------------------------- DATE n BUILDING PERMIT ISSUED----....__.__:.-___ J - - DATE_ ------- Alterations and/or recommendations-------------------.-------------------------- -------______________________ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ; ----•---------- --•---- ---- -------------------------- -- ----------- ----------------------------------------------------------------------------------------------- -- --- -------------------------------------------- FINAL INSPECTION BY:--------- �1.._. n_1<" - Date..... / - . - . ! -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT a 1801 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C{].