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F R O FICE USE: 3� k _7. . /6------- : f. // /T 1. APPLICATION FOR SANITATION PERMIT Permit No. . .. E� - w ----- (Complete in Duplicate) Date Issue a ---- ---------------- `7 -------------------------- -- d ---- --�� -��- -- - -- - - -- - ------------ -------'. This Permit Expires 1 Year From Date Issue 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 o. 544. - ------- JOB ADDRESS AND CATION--- -•-- � --O- f til-- lJ i Phon ------------------------------ " ---•- Owner's Name---------- ------------ -------- 1 '------------------------------------------------------ - Address-----------• - one.._ Contractor's Name___4`�-�•�- • --- ----- - - ❑ ❑ Installation will serve: Residence Apartment &use ❑ Commercial E] Trailer Court Motel ` Other [3 a-- ------------ Number of living units: Number of bedrooms .___—Number of baths _f..__ Lot size Water Supply: Public system ❑ . Community system ❑ Private ❑ Depth to Wafter Table.__-- _ ft. Ado �ardpan t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ ❑ Previous Application Made- (If yes,date-/----- ----) No ❑ New Construction: Yes ❑' Na FHA/VA: Yes ❑ 1No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: E i (No septic tank or cesspool permitted if public sewer is available within 200-feet.) i Noaof compartments}_well Size,Distance,from.foundati�quid dept _Material___-; Capacity ---- . sal istance from neares well.944x -Distance from:founcip n___- _. P--:_--__Distance to nearest lot line____'_ __...... .vJ Number of line--- -- _Length of each line__ __ ______ _______.Width of trench__- ��-- .----- - Q r =- (� Type of filter material- ----- --Depth of filter material___-- -----------Total length_- ---------• N +_�. _ See age Pi}: Distance to neares �well___.1_-_ _ _ Distance m oundafion____�____..____.:D s ce to nearest lot I' e�______________ I Size: Diameter_y ._.._ . De t'n-� ----------- ri m Number of pits---..______..__..--Lining ma;terial.1 �= ----- P i tante from nearest well________________Distance from oundation___________----___.Lining material-___.__________--_____-------- Distance ______.,__._�. Cesspool. D s al;. i� ❑ Size: Diameter----------------=-------------- p err ." . _».�-�•� -----Liquid Capacity-=----------------- Privy: Distance from nearest welll_sk---�------------------------------ Distance .from nearest building_---- ------------------------------- k r ❑ Distance to nearest;lot line .<,_ ------------------- -. --------- ----------------------- ------ . ` r a ------ -- --- ------ ----------------------------- ---- --------------------------- Remodeling and/or repairing'describe)------------ ---- � ----------- _ ---------------------- ---------------- ------------- -' •------ v - 4 ;� ,; { { ------------------- - - ----------•- -- -=-- r le <� -I- Pp the $an Joh 4 e work lth District.- -- --cor -- - - '------------------------ I - ---- ---------- ------------------ ----------------------------------- -ws and rules and regulations of-------------------------------------------- ----------- -h---.--------_---q--__--- - -_-�----.•------------ - •----{one,in accordance with San Joaquin County I hereby certify that I have prepared this a licatian and tha_t`the work will be d ordinances, tate , l s 1 �. nd/or Contractor) I -e------------------- k ____+___ ____ __ (Signed '"---- -- -- ------ --------- --- ---- - --------------------------- -------------------------------- -- - -- F t;= (Plot plan, showing size of lot, locationrof system in relatio =_wells, buildings, fit., can be placed on reverse side). i ....FOR DEPARTMENT USE ONLY } --Y- ---r.�-� --�-------:-�-------------- ----------------- ------ DATE-----==----��-�'-�� -------------- ---------- APPLICATION ACCEPTED BY___________--__ DATE-_------------------------ REVIEWED BY-------------------------------------------- • - ------------------- :----- ----- -------------------------------- BUILDING PERMIT ISSUED------------------------------- DY'` Alterations and/o reco a dations:---------- ---- --------------------------------------------- - __. 9�c ------ '------ ------------------------------------------------------------- N. -._.._- r . ------- --------------------------- i = -------------------------- ----------------------------------------------- --- /� /c er✓� Date---- --- r1 FINAL INSPECTION BY:_..._ ---------•-------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Californias Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 31A 3-'63 F.P.0D.