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FOR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT Permit No. -..... �G.., ----- -------------- --------- ------------------------- (Complete. in Duplicate) - -- - - -- Date Issued ---_--------------------------------------- .- I 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. JOB ADDRESS AND LOCATION. ----�1_----- 2'�c�4/1`��'i CLFF.----... Owners Name- -•----- " ... 1 Phone Address-----=-------- -_--------- :: --- -----------. ---------------------- --------------- ------ ---------•---------._.. Contractor's Name t Q�.�'. Phone............... I Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms,.__. Number of baths Z___ Lot size ----------__-_-___--_----A-- - ----------- Water Supply: Public system' El1 Community system El Private Depth to Water Table --15- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loa ❑ Clay Loam ❑ Clay ❑ Adobe e Hardpan ❑ Previous Application Made: (If yes;date.-_-- A-.__-)' N'o [�New-Cons#ruction: Yes ❑ No FHA/VA: Yes �No ❑ PP fp-m &I TYPE OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool permitted if public sewer,is available wkthin 200 feet.) p P pis#ante from foundation_____ _ ___ _____Material__. _ - __-____._._.__--_-. Se tic Tank: Distance from nearest well -__.-_ / If -a t Ga/ -)-•-�- y-�"-j- Liquid depth t P Y No. of tom artments_-_-- --------------'Size. ki r Ca acit Disposal eld: Distance from nearest. well --..!SD from foundation-_ 1-4--_-.Distance to nearest lot line_--_��____ lV Number of lines-------3---------------- ----Length of each line--_c. __ ►_$b--Width of trench.-_��___---_-�_-.--.--:---------. � Type of filter material-_1 ea41�:_Oz�j Depth of filter material_-- ` - -----_..Total length_----sem_ - !�---------------•.- Seepage Pit: Distance to nearest well------ --------------Distance from foundation-----------------.-.Distance to nearest lot line-------._---_-.-_ ❑ Number of pits----------------------Lining material------------- -------Size: Diameter-----------------------Deptn-------:------ - - Cesspool: Distanceifrom nearest well--------------__Distance from foundation..------------------Lining material-__-.-._-.-__---._-._-_--_.-------.-. y ❑ Size: Diameter------------------------- -----------Depth---- -- ----------------------=-----------------Liquid Capacity----------------------------gals. .5 Privy: Distance'�from nearest well--------------:--_ _._--_._.____-----------------Distance from nearest building-----------------------------------------. ❑ Distance'!to nearest lot line--•--------------------------------- I -- ------------------ ----------••--------------•----------------------- -------------=------------------ rbe Remodeling and or repairing: (desc - N ; 1I ------ ------------------------------------- -------------------P__:------- — _.pp_-::--------_;;: =- -- --- _ - __ ... _Y, -r. I hereby certify that I have re ared 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) -R'Q-A!a------- -- ---------- --------- ----------------------------- ----------------- ------------------• -(Owner and/or Contractor) By:... t f - Ti le) �Q-t ------------•--------; L ,� { _ t (Plot plan, showing size of lot, locati of system in relation`to�irells, buildings, etc., can be placed on reverse side). i t ' FOR DEPARTMENT USE ONLY c APPLICATION ACCEPTED,BY-----.--- ---------------------------- -----------------� DATE------- T -- ------------•-------- ---------- REVIEWED'BY--------------------------------------------- -------------------- ----------------- DATE BUILDING PERMIT ISSUED------------------------- ------------------------------------------:--------------- DATE.-- ATE. ---±-----•------------------------------------- , _Alterations and/or ecommendatio s:..........................__-_---._-___--._---____ '_ ---- --�= -------_- -------------------------------------- ------------ -------------------------- -- y - _________________________ !___.__ -- { ------------------------------------------- ____________________________________ ` 11 .____-_.--_ , - FINAL INSPECTION BY:.-- e�./.•r'.cQ---------- --------•----- � Date--------1�---�.�-=---1�----�--------------------------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT, N' 1601 E.Haselton Ave.;}, 300 West Oak Street1.24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 REVISED 8.59 31A 3-'63 F,P.CO. - � f f