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/I FOR OFFICE USE: ,E - - f 2f r �` 'a-------- / '� Permit No. .. 1- �✓ --/�- /- �G APPLICATION FOR SANITATION PERMIT I .---•--•-�.-•. ----- -------------------------------- ----------------- (Complete in Duplicate) 9�� 1°• Date Issued ._-•-- - -------- _---- ------------------ - ---- _-- This Permit Expires 1.Year From Date Issued'< Y I -------- - 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. 9. t JOBADDRESS AND � CATION------,1�� -------------`------- --------------------•--•--=--------------------------------------------- Owner's Name--------- -- Phone----------- Address---,------------ f} �f+F" .C. -- ---------------------------------------------------------------------------•---------------------------------- Contractor's Name---------------------- Phone = Installation will serve: 'Residence//F] Apartment House ❑n Commercial ❑ Trailer Court ❑/�Mjote l ❑l Other ElS Number of living units: -!_____ Number of bedrooms __f' Number of baths _/' Lot'size ----------------------------- A Water Supply: Public system �Cormmunity system ❑ Private ❑ Depth to Water Table . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made:. {lf yes,date---------...--------) No New Construction: Yes K4.-,14o ❑ FHA/VA: Yeses► No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Sepfiic Ta Distance from nearest wel_._"'��--__Distance rom found�afiion___ __.Mat �I_ '' _�> __ _-,---- -)---..•s No. of compartments---- --------------Size>e -------Liquid depth__ .-•_.------.-Capacity_a--r ------ r S� Disposal Field: Distance from nearest well_._�-----._.Distance from foundati �---_____.Distance to nearest I line_________________ Number of lines__________ ___ ____ ______ Length of each line ----:Width of trench - Type.of filter material Depth of filter material f R -" Total length--- --- f�__._D• t n e to nearest lot li et�___._ Seepag st: Distance to nearest well/__-- ~_-___Distance fr fo dation___ ___ ___-_ Number of pits__'rA---/--------Lining material__ .Size: Diameter- ------D_ptn ---------•--------- - N Cesspool: Distance from nearest well-----------------Distance from foundation----------------------Lining`material___________-____._--_______._____---_. ❑ Size: Diameter-------------------- -------•-------Depth------------------------------- -----------Liquid Capacity....----------------- gals. Privy: --:_-•---------------------------- -------------Distance from -nearest buildin------------------------------- Priv Distance from nearest well building------------------------------ FT Distance to nearest lot line-------------------------------- ------ ------------- ------------ ----------- --- y Remodeling and/o repairing (d scribes------- --- -- --------------- ------ , --- - - ----- -- ----- - -------- 7{ ------------------------------ ---------------------1------------------------- ---••------••-•---------------------•---------------------------------------------------------I-------------------------------------------------------------------- t 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,Anda rules ano regulat'ons of the San Joaquin Local Health District. { j - y (Signed) { e� Contractor} ` By:-------------------------------------------------------------------- --� (Plot plan, showing size of lot, location of syste elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------------------------------------------••----------- DATE - z -------- -------- sl REVIEWED BY----------------------------------- - -- --- ---------------- DATE-----=--------------------- --- ----------- - -- -- ----- -------------------- -------------------------- -- � :-------------- BUILDING PERMIT ISSUED------- ------------------ ----------- ------------------------ --------- DATE---------- ---------- ± Alterations and/or r ecomnienclations_ - ------------ ------------- -- -- ----- -------- ------------ --------------- -- - --- --- ---- �' --_----� -- ----- ---------- --------- ---------------------------------- '--------------------- - -------------------- ---- ------------------- ------------------------------------------------------------- ------ III. ------------------------------------------------ ev 01A FINAL INSPECTION BY:-.--- --C.- e0-'-------------------- ------------- Date....... ----rJ�L4�-.�---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 3M 3•-63 f-P.DD, ,