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FUR OFFICE USE: — — y ------------------------------------------------- --- ------ - -- ------ ------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------- --------------------------..---- ------------- (Complete in Duplicate) ., .. .._ --------------------------------------------- - This Permit Ex"ires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the ork here' �e ribed. This application is made.in compliance with County Ordinance No. 549. ,�� jw JOB ADDRESS AND LOCATION Owner's Name_ .. -- hone----- ---- _ ' . -------------------------------•--- Contractor's Name_________ _ _ _� ._ ••� /". t one -------------------------------------------------- Ph Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court Motel El Other El Number of living units: _/__. Number of bedrooms_-- Number of baths--- Lot size �t!1 .Q �----- Water Supply: Public system ❑ Community system ❑ -Private ZKDepth to Water Table ft. 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam M'Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ i Previous Application Mader (If yes date._..______ ____.._) No (? New Construction: Yes �No ❑ FHA/VA: Yes ❑ No ❑ (�'� TYPE OF INSTALLATION AND SPECIFICATIONS: - �L' [No septic tank or cesspool permitted if public sewer is available within 200 feet.] ! Septic Tank: Distance from nearest well_-/pr�Distance from foundation__-_ m artments_. �9 / No, of co ' P #�' _Size y F K, .Liquid depth -Ca acit Z P Disposal Field: Distance from nearest welL_X_0 "Distance from foundation__.lt�9___ _____Distance to nearest lot line__r _______ Number of lines____s�_-.___ __ Length of each line_ ___��` �. -�------------- g �---- --- ":rE------..Width of trench---A-------------- ------------ Type of filter,material- .0&eDepth of filter material""11P----_-_---_Total length_-, --------------- ----- __""-.""""-_- Seepage Pit: Distance to nearest well"- ---Distance f m f ndation___.____ # i 1'�..____.Distance to nearest lot line__-"""-.- Number of pits____-________"-Lining material- �10--.Size:'Diameter_ _`_- ' " - _Depth_ _-.��1�'. Cesspool: Distance from nearest.well_______________--Distance from foundation------------------- Lining material_._.__-____--_____.._____________.__ . ❑ Size: Diameter------------- ------------------------Depth----------- ----------- -----------Liquid Capacity----•--------------- ----_gals. r r Privy: Distance from nearest well-""""`--- ____-`__ .____r-'- i- _Distance from nearest building------------------------------------------ El Distance to nearest lot line--- ---------------- Remodeling and/or repairing (describe):-- --------.411C.V-----t5 � ----------------------- __---------------------______________ -_-____-__--__ ___________________i F_______F__------------------------------------------------- _ ____-____._.-_____-_--_-.__ ------------------ _______________--------------------------- _-------------------- I hereby certify that I hayegp�epared this application and that the work will be done in accordance with San Joaquin County N. ordinances, State laws, and rules and regulations of the San Joaquin focal Health District. ; y c�^1* {Signed!---------------------�R 7,0#: y� r�j� - arf j . _ ... - ------------- ----------------- By:_ n r Contract ] :.. ----------------------- ••-------•----•--- ---- = - ----------------- (Title)- - - {Owner and/or or (Plot pian, showing size of lot, location of•system i r ation to wells,,buildings,.etc.,rcan;.be,placed on reverse side). FOR DEPARTMENT USE ONLY (T APPLICATION'ACCEPTED BY_;_N . ------ -------------------------------------- DATE-- = `>�C7 REVIEWEDBY---------------------------- DATE--------------------- ------ ----------------------------- ---- - -- --------------------------- UILDING PERMIT ISSUED--- -------------- ----------------------------=- ---=---------------------- ------------------------------------------------------------- bATE------------------------------------------------------------------------------------------------------ ---------- Aterations and/or recommendations____________________ s ----------------------------------------------------------•--------•-------------------------------------------------------------------••--------•--------------•------•----------------------------------------- ----- -----------------------------•------------------------- - ----------------------------------- FINAL INSPECTION BY:- . .. Y M Dateffl.'_. _` -------------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeiton Ave. � `,+ 300 West Oak Street 124 Sycamore Street 205 West 9th Street f Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REvtSED 6-59 3M 3-'63 F.P.CO. t r _