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FOR OFFICE USE: ' ----- ---------- -- - --------- APPLICATION FOR SANITATION PERMIT Permit No. ....l--_ !-__ - ---•--•----------..........-' ----- -- (Complete in Duplicate) Date Issued ------ ---------------------------- -- -sl- _-�� _------------------------.___ 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 County Ordinance No. 549. ' 1�75C LCW' JOB ADDRESS AND LOCATION- Owner's Name------- ---:-•-------- -----•-------------------- -- -- ------------------------------------ Phone----•--------------------=---------- Address --- ..- �`� ---- ECflirfl ----------------------------------------------------- - --- -------------- Contractor's Name------- -----------------------------------------I -------------•-------------•------------------ Phone--------------.__----------- Installation will serve: Residence Apartment House ❑ Commercial' ❑ Trailer Court ❑ Motel ❑ Other-[] i Number of living units: __�___° Number of bedrooms . ___ Number of baths __ ----- Lot size ______1QQ---K._....3 2.______--_______ [ Water Supply: Public sy tem ❑ 'Community system ❑ Private Depth to.Water Table _Y ft. Character of soil to a depth of�3 feet: - Sand Gravel ❑ Sandy. Loam ❑ r.Clay Loam [:] Clay,[] Adobe❑ Hardpan ❑ " Previous Application Made: (If yes,�date_— ......I-No'�New-Con-Wuction: 'Yes ��NO'E]- FHA/VA: Yes 93-- No ❑ _ _ _ _ _ TYPE OF INSTALLATION',AND SPECIFICATIONS: (No septic tank or cesspool;permitted if public sewer is available within 204 feet.] � /0 r W Septic.Tank: Distance from rnearest,well---- �__--_Distances from foundation_..!_D_- ---- ____- r No. of compartments___F_L.__—_____________Size_L ��n-x-��--Liquid depth___/S----------Capacity___/ZQ_.___-_- Disposal Field:--" Distance from,"nearest well__ ---------Distance from foundation___A2___r__Distance to nearest lot line---- i [ Number of lines"` -----------------Length of,each line---------- - =Total hien #h of rch...I� Q6__'`____________ Type of filter rr�aterial't�Q CK__Depths ofTfilter. material____._l� g Seepage Pit: Distance to nearest well-_______; ----------Distance from foundation___________________.Distance to nearest lot line----------------- Number of pits---------------- ----Lining material-\--'---\---.--------Size: Diameter---,-------------------Depth-------------------.------------- Cesspool: Distance from'nearest well----_----- ---Distance ftnom foundation------------------- Lining material----------------.--------------- ____. 0 Size: Diameter-------=----------------------------`Depth--------j-;"----------------------------------.-----Liquid Capacity-.--------------------------gals. f Privy: Distance from nearest well_____,_ _______ _ _____y- __-�_ Dstanm ce,�fronearest building_ ___ __ __ __.__ _.___._ �. ❑ Distance to nearest.lot line----- ------------------ -----_---- ------ ------ ----------------------- - ....------ �� ----------- Remodeling and/or repaErrng (describe): : -- -- --------------- - ----•------•- ---------•------------------------------------------ - 1 ------------------- --- ------------------------------------------------ `. ---------------------y y---------- -;------------- --------------------------- - . �. - `'- q Y a _r tr I here6 cer#' that Is ave re ared this application and that the work will be donetm accordance with San Joaquin Count ordinances,, ate.l s,�and rul d regulations of the San Joaquin Local Health District. �.-- (Signed}-� ___-- Y _ I At. (Owner and/or,Contkactor} � --- + _. BY - '' -------- fie} (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can,be placed on reverse side). w t 1 FOR DEPARTMENT USE ONLY . • - ----` � 1 +- 2a �_ APPLICATION ACCEPTED gY-----'-`-,+`.-.i.R:�--- - - � -- -----------------------•---------•------------- DATE-------- --_--------- ----- -----z------------- REVIEWED BY---------------------------------- BUILDING PERMIT-ISSUED-=--- ---"`=`=---_--_ . .- =•--.--' DA-TE--------------------------------------------------------------------------- Alterationsarid/or recommendation ��- - s i t r :i --------------•------•----=----------------------------------------------------------------------------------------------------------- •-•--------- ------ ------------------------------------------------------------------- ------------------------------------- r ---_----_---_-----------------------------.------- _ ____ _ _._ -- _._ __ _ ...........----------- ---------------------------------------------------- . FINAL INSPEC G/'sr- ------ ----- - - - - Date- -- --- _1_._`. ----------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVI6EO 9-59 3M 3-'63 F.P.C .