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FOR OFFICE USE: ------------------ :------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------- -------------------------------------------- - ------------------ - ------ ..- ------ ---- -- (Complete in Duplicate) Issued'_-�h_fAy 41 .- Date Issued Date ------------------- -- ----------- ---------------- I This Permit Expires I Year From Application is hereby made to the,San Joaquin Local Health District for a permit to construct and install the work herein d 1 This application is made in complia'nce with County Ordinance No. 549. /,4A-J 005- 7 erein 7pribed � k,? ' JOB ADDRESS ANDLOCATION 5--------- ------------ ------------ O� -------- ------ --------- -- --------- ------ -7--------- wrierse----It-, -------- - -------------- - ----- ---------- ?. ---------•-----------------------------------•----------- -- --------------- ---- --- - - --------- - ------------- - Address - -------------------- Phone. -------------------- Contractor's Name--•------- 1- A_- - --------- -------- ---------- ----- ---- ------- 1- --- --- Motel ❑ Other Installation will serve: Residence Ap rtment_Hb6S6 CommercialE] Trailer Court ❑ ❑ Number of living units: .__,i` bedrooms�4 f size ------------------------- _, -- bath, I--- Lo '!'Commun�itjl 'stem El Private to Wafer Table Wafer Supply: Public system El :1 y SY 1� Clay Loam' 0 Clay Ej Adobe L] Hardpan Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El In_� _F�_w Construction: Yes ❑ No No E]l Previous Application Made: (If ye s,date---------- No C3 FHA/VA- Yes 0 TYPE OF INSTALLATION AND SPECIFICATIONS-- �s (No septic tank or cesspool permitted if public sewer is-available within 200'feet.) istam from foundafion-..'10----------M f Val Se nk:' Distance -from 1!nearest well-__,_60---- D _!�-------------- - p ---Liquid dep�h------ ity I- ------- --- No. of compartments--------A----------- SizeO_ X ---------------Capacity- I—C, Dis Field: Distance from nearest well ----Distance from foundation__ 141 Disfan5;e to nearest loth ----------- of frenr_h___ /7------------------- Number of line"S__ Length of each line-90-77 71 Type of filter 'm�' a�.ria V, A -----Depth of filter material_____ ---Total length--,- See Pit: Distance to nearest -------Distance I fo riclation------------ ......Distance to nearest lot I' --------- , W ye Lining m ...size: ---------------------- -- 10, p/Cle Number of pits___ Distance from 11 nearest well_______._______Distance from foundation--------------------Lining material--.---------------- ------------ All Size: Diarriete' -----------De pt h--------------------------------- ---- --------; Liquid Capacity----------------------------gals. -------------------------- Privy: Distance frominearest well-------------------------------------------------Distance from nearest builcling_l------------------------------------------ ElDistance to nJ are. st lot line--- ------------- --- -----------------------------------------------z------------------------------------------------------------- ------ -�O Remodelingand/or repairing (des`cribe):-------------------------------------------------------------------------•---- -------------------------------_-•------------------------------------1___-------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------------------------ -------------------------------- ----------------------------------------------_------------------------------------------------------- ---------------------------------------------------------------------- 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)---------- I ------- ------------------- --------- -- - ---- - ------------------ -----------------------------------------------------------------r:r-.�. �nd/or Contractor) __ _4 1 . &,)._e - 9 -_ 4.4—----------------------------------------------(Title).......---- ------------------ ........... ----------- By:--.-- -- --------••----------------A-------- --- - ---- -- - I , (Plot plan, showing size of lot, locl"tion of system in r4stion to wells, buildings, etc., can be placed on reverse side). ir FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - ----------- --w------------------------------------------------------- DATE-------------------------- ----------------------------- -- - --- ----- REVIEWED BY-------- ---------------------------------------------------------------------------------- --------- DATE------------------------------------------------------------ ----------------------- BUILDING PERMIT ISSUED----------1t= --------------------------------: -- - - DATE - - :-------------------- Alterationsand/or recommendations:-- --------------- ------------------- --- ---------------------------------------------------- -------------------------- --------------------_ ----------- -------------------------------------------------------------- ------------------------------------------------• •------------------------------------------------------------------------------------ 9: -------------------------------- --------_---- --------------------- ----------------I ------------------------------------------------------------------ --------------------------------------------------------------- 0 --- -------------------------------------------------------------------------------------- ----------------------------- -=--------------------------------------------------------- ---------- ------------------------ ---------- -- ------------------------- ---------------------------------------------------------------- ------- ---------------------- ------------------------------- --- - FINAL INSPECTION BY:. Date----------------- - -;--------------- ------------- -------- --------- .- --- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California VS 9 REVISED 8-59 3M 3-'63 F,F'.CQ.