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FOIL OFFICE USE: -------------- -,Alt --------------- w. ��63 ---- -- APPLICATION FOR=SANITATION PERMIT Permit No. ... ....... ...... --- -------- --------------------------------------------- (Complete in Duplicate) 1 '1 / Date Issued :__.___-.---Irb _ ---_-------------------------------------------------- This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to construct and insi-a{l the work herein described. This application is made in compliance with County Ordinance No. 549. _• , J ----------------- -----------------•-•--------------------------------•---- ---•-• f JOB ADDRESS AND CATION___ __ ___.___...�'�i_BiGJII--�(.rr��•------,----- Owner's Name �'' � ,, �s� ) -------------------•----- ------------------- ------------------ Phone------------------------------------ Address --------------------------•-•----------------------•------------------- i Contractor's Name--------- --- 4 _ --------------------------------------------------------- --------------- Phone---_----------------.--••------•---- Installation will serve: Reside a @.Apartment House ❑'-"Commercial'❑Trailei'Court"❑Motel ❑ Other ❑ sl Number of living units: _/__ Number of bedrooms_ Number of baths , Lot size `_-- t Water Supply: Public'system ❑ Community system rivate ❑ Depth to Water Table 4W_ tt. j € Character of soil to a dept h of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ 'Adobe[�1qardpan ❑ Previous Application Made: (If yes,date-----------.........] No New Construction: Yes o ❑ FHA/,VA: Yes 9�— No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool:permitted A public sewer is available�wlthiny200 feet.) Septic Tank: Distance,from nearest well ---- ; --Distan frjpm founds ion__.f49-------Mater- !��--- ------- No. of;compartments___/ ------------ SizeJh-./_�_f _-___Liquid depth___ -- ..._ Capacity__ 4 �Q- __Distance to nearest lot line_t0_~f- Disposal Field: Distance from nearest well__-_._...__......Distance from faundation__�_._. __ Z � Numberlof lines-._-f f.._ ______'Length of each __.Width of trerich_._. Type of'filter materia -_ - Depth of filter material-___. ------Total length___/��_____---..____ _--_ J Seepage Pit: Distante*to-nearest-well------ _- `- Distance from foundation-_,-0---/_-�_._.Dis annce to nearest lot lice-h; (� Number•of pits:-- -.._----_.-Lining material e�/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.------------------------------------------ --------------- _- _---________..__ + ❑ Distance to nearest lot line--------- --------- ---------- ------------------------ Remodeling ----- ------- J - t 1 ------------------------------•---- Remodeling and/or repairing (describe): -- - --------- ----------- •• -•- -- -- ------ -- - -- - - --...---� } •--------------------------------------------------•--- ------=-------------------- --------------------•----------------•-------- ----- --------- - 1 ----- ----------------------------------------------------------------------- - 1 -- - ------------------------------------f-----------------------------'"3, :--------------------•--------------------------------------••--.------ :-----------------------------------•----------------- -- --- -y y P papplication ----- -- . .� I hereby certify that I have re ared this 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, �/� - --- - -=-- Contractor) (Signed) 'G�r� ---- g �• I --- ---- ------ -- y------------------------•---------- = :%% (Title). 4 (Plot plan, showing size of lot, location of system i ation to wells, buildings, etc., can be placed on reverse FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.____ Y �Z--- -- -------------------------------------- DATE-----/ f--- - REVIEWED.BY.------ ------ ----- -------------------- ----------------------------------------------- DATE------------------------------------------------------------- I BUILDING PERMIT ISSUED--•------------------------------ ----------------------------------------------- DATE Alterations and/or recommen atio�ls:. `...____ _�--�� �� L �y --------------=---------- -------------------•----------------------------=----- ------------------------------------------------------•---------------- ------------------------------------------------------ I} ----------------•------------------- ---- ---------------------------- i ---•-----------•--------------- -- --------------------------------------------------------- - ----- - x I - SDateFENAL INSPECTION BY:--- ----- ; _-- --•- ------------------- ----- --- ------------- A TH DISTRICTSAN JOAQUIN�LOCA:�.HE 1601 E.Ha=ellon Ave. 300 West Oak Street 124 Sycamore Street \ 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVIGED 6-59 3M 3-'63 F.P.00.