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FOR OFFICE USE: 1 - -------------------------- -------- - - --- -- -------------------------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. 41 ------------------------------------------ ------ -- - (Complete in Duplicate) ------- -- ___ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal4 the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION._ �L/_ __ _.._i_._ ____ F Owner's Name - �,�1 ✓ - ---------•----------- Ph-- ------ on -_7_/-W---•---- Address.................oe It. Sax----- - -----e�------------------- --- -------- Contractor's Name ------------------------- ------------------ - ---- ---- - ------------- PhonQ.`_7D __.[_ _ Installation will serve: Residence [i!�—Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -./---- Number of bedrooms r _ Number of baths .-I__- Lot size __ //. ---------------------------"-_ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table/0__ f+. Character of soil to a depth of 3 feet: - Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan ` Previous Application Made: (If.yes,date......... --------.I No [� New Construction: Yes El No FHA/VA: Yes E] No �� ==TYPE OF-INSTAL-L-ATION AND"SPECIFICATIONS: (No septic tanVor cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-_-.--------------------------."_-____.___.___. ❑ No. of compartments--------------=----------Size--------------------------------Liquid clth--------- ---------------Capacity---------------------- r Disposal Field: Distance from_nearest well._-42-___._Distance from foundation./-._.__-____..Distance to nearest lot line-1/3-----_-- Number of lines---------- ---- ------Length of each line______ ..........Width of -- --t-` + rent��-__._____._______-. Type of filter material$07--_ ._ 4Y10-pth cf filter ---------"Total length + Seepage i Pit: Distance to nearest well_. _ Distance from foundation -.--.Distance to nearest lot line----------------- ❑ 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----------------------------------------------- from nearest buiVng-----._._____.______.__--_---._--_------. ❑ Distance to nearest lot line---------------- ---- ----- - ----------------_--------------------- ------------ ------ Remode g and/or repairin (descr _ - fy - �'r _ _--_•------------------" „(JI JtL. ------- - *'"�- - rrrrt� i de- ------------- ---------------- ---- ----------- 'R' --------------- I hereby certify that 1 have prepar d this application and that the work will be done in accordance with San Joaquin County ordinances tate laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- ----- X �..iei S- ��.�?-.RJ -. ----(Owner and/or Contractor) t By:.- Aof ------- - - ---------- - =' ------------ _(Title)__ _ --------- (Piot plan, showing size lot, location of sy in relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT SE ONLY APPLICATION ACCEPTED BY---- - -- --7_ R�� DATE_____1C_- zO-� E 6-------------------- REVIEWEDBY------------------------- ------ -- - --- --------------------------------------- - ----------------------------------------- DATE----------------------------------------------------------- BUILDING ------ ------------------------------- BUILDINGPERMIT ISSUED------------------------------------------- ---------------------------------------------------------- DATE----------------- --------------- ----------------------- --- Alterations and/or recommendations----------- --- ---------------- - ------ ----- ---.--......--------------------•----------------------•------------------------------------ ------------------- ----------------------------- -------------- --------'----------------------------------------------------- ----- l ----- --- --------------- ---------------—---------- ---- - --- - ---- b FINAL INSP -- ----- --------------- Date--------------------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street Y 205 West 9th Street ,a Stockton,California Lodi,California Manteca, California Tracy,.Caiiforriid F.P.CO.