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t Fq OFFICE USE: / p, - = ---------- --. Q �" _.__-_-___l9_. APPLICATION FOR SANITATION PERMIT Permit No. `� -ai ------- -- --------------- (Complete in Duplicafe) I } Date Issued ----��( � -------� ---------------- - -�-------------- - �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 Count e No. 549. v?v I� JOB ADDRESS AND OCATION; I Owner's Name---- "�' = ' ''"" • -- ---------- -------------- �` ---ti fix: ------------------------------------ ----------------Address_ � :' _ _ .._.. �.... -- •--------------- --•----------------•----- Contractor's Name-------------- . .! ----�_ ----------------------------------------- Phone_---••---•-----•----••--•------,_.. Installation will serve: Residence Ug- Apartment House ❑ Commercial ❑ Trailer Court ❑ I Motel ❑ Other ❑ or Number of living units: ---/--,Number of bedrooms -. Number of baths l___ Lot size'--Q- -- -------- _ ________________________________ Wafer Supply: Public,system � ppY� y ❑ Community system Private ❑ Depth�to Water Table �'•sft: p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe Hardpan ❑ j f a Previous Application Made: (if yes,date--------------- , .l No ❑ ;New Construction: Yes ❑ No D] FHA/VA: Yes I--] No 11 ~-- TYPE OF INSTALLATION AND SPECIFICATIONS---__ " (No septic tank or cesspool permitted if public-sewer is- vailable within 200 feet.)_ Septic Tank: Distance from nearest wel ' ------Distance from fou�datiori` A` - 1 Y {{� n . __;f_ ------------- (% [ No. of compartments------ •--- __ --------------$ize__0�__tCt- KA"'---Liquid depth_._---'��--------Capacifi f r _ Disposal Field: Distance from nearest well- -- Distance from foundation.__f©_______.Disfiance to nearest lot.line_s ,--�_ . Number of lines---;;4n------------------- ----Length of each line--- ----------Width of trench---, -------------------------- Type of filter material ,/ Depth of filter material__ - __----Total length_--Z4-- - -__ _ Seepage Pit: Distance to nearest-well_____ __ _____ omafoundation _,�e�:._: 'stance to nearest lot lime C ___Distance fr Number of pits____��------_________Lining material_;%/ _-Size: diameter :'_- -------Depth_ `� � ./ Cesspool: Distance from nearest well--------------- Distance from foundation--------------------Lining material__.____-.-_-___________ Size- Diameter------------------------------------ -Depth-------------------------- -------------------Liquid Capacity------- gals. Privy: Distance from,nearest_well-,___________-__-_____________________________Distance..from .nearest building------ -----------------------=---------- f�- ❑ Distance to nearest lot line - , Remodeling and/or repairing (descr _ i e}:_ _ 'I --------------• ----------• --------------- ______________________________ ___________________-_--__----_____...__________--___________-__';___________________-__---___________________,__________-___„____._____.,________-________--._____-_______-_-______#---------------------------------_ I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County- ordinances, State laws, and rules and .regulations of the San Joaquin Local Health District. r , (Signed) - n --------------'(8wrrerantf i BY:----------------------------------------- = _ " _ Title _ or Contra c#or) - - - - ------ (Plot plan, showing size of lot, locafiori of stem in relation_to-wellsr.buildingsi,efc.,,.can_.be-placed on reverse side). FOR DEPARTMENT USE ONLY I k -- APPLICATION ACCEPTED BY ------------------ - - �- -( �' DATE - REVIEWED BY ------ -----------------------• DATE I -7 = = UILDING PERMIT ISSUED------------------------------------ ---------------, DATE------------------ Alterations and/or recommendations:-____/of' - I f sa_ _. - - "- -= T-------------------- ' �P� - ------�-ms--- -----t B-` � - - ----- ------ �--------- --- --------- ---------------------------- -------------- -------------- --------------------- ----------------------- -------- FINAL INSPECTION BY: = [ ------- ------------ Date 4 i SAN JOAQUIN LOCAL HEALTH DISTRICT_'. ' . 1661,.E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street I t r 205 West 9th Street Stockton,California T. :,-0 a". oLodi,-California . '; MTrac '.� �`:�. anteca��}f._ .•.1 °,� �,x _ <f Yr California ES 9 REVISED 6-59 3M 3-'63 F.P.CQ,