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FOR OFFICE PSE: �-- �►� :4-�__._ .�_�_ -�_�__ -- APPLICATION _FOR SANITATION PERMIT Permit No. ..f12 �J f ------------`---------------------------------- ------ {Complete in Duplicate) CVj�/ia� ------------ -- This Permit Expires T 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 work herein described. This application is made in compliance with County Ordinance I No. 549. JOB ADDRESS AND LOCATION.-!-/ I Owner's Name-------/::G?. __ _.1/x-_!__1212 Q`� !/ _l''L�C. Phoi;v .- _ 7- Address...................... P________________________________________:___________.__________._________... _ Contractor's Name_OfI_Et__._ _ .- .��Xz_ --- C------------------------- ---------- Phon ----[? � �__. Installation will serve: Residence [�partment House ❑ Commercial ❑ 'Trailer Court ❑ Motel ❑ Other ❑ Number of living units: N ber of bedrooms _ __ Number of baths _ ___ Lot size _ -- ---_---�„`,i'c�'J ' ---------- Water Supply: Public system � unify system ❑ Private ❑ Depth to Water Table �6,4ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe k Hardpan ❑ Previous Application Made: {If yes,date__.._--- ---------I No ElNew Construction: Yes E] No [4r;;�PHtA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: l� O (No r septic tank or cesspool permitted if public sewer is available within 200 feet.) ticf Distance from nearest well_________________Distance from foundation-------------------,Material______- .............. No. of compartments----------------------r__Size--------------------------------Liquid d�jh-------------- -------- Capacity-•--- spo� I d Distance from nearest well-10 0-f.-Distance from foundation___ _ _ ____Distance to nearest lot line----l.�J._�. ( Number of lines-.__1______ .-. Length of each line�4__'_----- --____.Width of trench___�-------------------------- Type Z.. ---_________ Sae a e P t rr � Type of filter material _ItSr___.__ ._Depth of filter mater:al___._1_ ----------- otal length-------------- ��__------ ' f Pit: Distance to nearest well from foundation----��_--__.Distance to nearest lot lane__--- -.- Number of pits-- ----------------Lining material_RQ_G�-------Size: Diametere_,�yo---- ____.Depth------ - -- Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material-----------.---_-...______._______._ I ❑ Size: Diameter---------------------------------------Depth-------------------•-------------------------------Liquid Capacity--------------------- gals. Privy: Distance from nearest well___-----------------------------______-------------Distance from nearest building.____..____________-________ ❑ Distance to nearest lot line------------------- --------------------------------------------------------------------------------- ------------------ �� t Remodeling and/or repairing (describe):----------- --------•--------------------•---- -------- ------------------------------------------------------------------------------------ --------------------------•------------------------------------------•--..._---------------------•--------------------------------- ---- ,t- ----------- ------•--------------------------------•------------------------------------------------------------------------------------------•---------------------------------------------------------------------------- I hereby certify that I have prepared 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. t a �. �j. (Signed) a- ---�' 11-- ! :-X,,nells.. ; �-I----/--- - (�-e'r Contractor) By----------------------------------------- / t ----•----(Title)---------- -------- (Plot plan, showing size of lot, location of system in rbuilding(etc., can be placed on reverse side). - W=- - --� + FOR DEPARTMENT USE ONLY APPLICATION ACCE=PTED BY------ •--- -`- &Ice----------- -------------------------------------------------- DATE-------0 " REVIEWEDBY--- -----------•--------------------------------------------------1-------------- ------------- --------• DATE----------------------- BUILDING PERMIT ISSUED------•-------------------------------- -------------------------------------------------------- DATE_ Alterations and/or recommendations}„__ -__.:�-- _____ l`� ----.=r --------- / . -� --- -------------- D� ---- ---------- ` -= 1 .- 3 - _ ----5 = -:�'z.2. c --- ------- ' _------------------ -------------- -------------------------- ---_----------------------- --------------------------------- ------ ----------------------------------------------------------------------------------------------------- � -------------- ---------------- ------------------------------------- ---------:------- ----------------------------------- ---------------------------------.-----------------------�-- ---------------------- - ._-. -' •.. .. FINAL INSPECTION BY:........ �'�'---------------------- -- -- Date ------- ------- -- --------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 13-59 3M 3-'63 F.p.CQ.