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F R OFFICE USE: --_ �tr: APPLICATION FOR SANITATION PERMIT Permit No. _1.7:�.7`l� �•----- ------------------ -- -------------- (Complete in Duplicate) �� _ Date Issued .... ..... .... T _------------------------- 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 JOS ADDRESS A LOCATIO a =�"---•------------------------ Owner's NameD �4Q }-- e-O -t-- ------ --------- Phone q -------------------- I Address--------------'�--��--:f------��---�- -�-�`--- -- -----•-- - ------------- ✓L_-- eJ- -- -------- Phone_ Contractor's Name-----� •--- --�_-'•- •- -- -� ------- - - --- �-•• - --- Trailer Court Motel Other ---------- Installation will serve:�2esidenct��Apartment House ❑ Commercial ❑ ❑. ❑ ❑ _ Number of living units:,_'7'/Number of bedrooms Number of baths 'Lot size ----- f/---d`--�----- ---------- Water Supply: Public system gy Community system ❑ Private ❑ Depth to Water Table _ __ __ ft.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe. ardpan ❑ Previous Application Made: (If yes,date..........._........) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATIOWAND SPECIFICATIONS: (No septic tank or cesspool permitted if p blit sewer is available within-200 feet.) Septic Tank: Distance from nearest well Distance from f undation__p Material__ d �- ----------- �t6_.� -` -- __zC_ Liquid depth__._ej Z_ .---Capacity.Z.7v-0(7 �r No. of compartments--_��,_____..____Size� �_� - --_-____ Mosall IF' Distance from nearest weII1kbK9-_/-_Distance from foundation_____f,0_.._-___Distance to nearest lot line--- ?__........ Number of lines___;_ _____ _______, ___ _______Length of each line__--l_-�--------------Width of trench__ �'!�-_-_-._-___._- Type of filter matenal� - Depth of filter material----�y-- _-___-_Total length------------1 _------,_______.__ i a e �, listance to nearest well_-th�_iin, -._._--Distance from foundation--- _..Distance to nearest lot line__-____a2 �( Humber of pits----f----------------Lining material_ ____ - ._ -_--_Size: Diameter,3-3_F-_-__----__-Depth_Z.T.................... C i 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 b0cling------------------------------------------ C ❑ Distance to nearest lot line---------------------------------- ------------------------------------ ---------------------- --------------------------------------------- 1 Remodeling and/or repairing (describe):----- r - -- A , --- R ............ 4pi ----- - ------__ --------- --------------•._•-------------------------------- ---------- --------- ------1----------------------------- I hereby certify that I have prepared thison and that the wo will be done in accordance with San Joaquin County ordinances, S+ t ws, d rules and regulations of the San Joaquin Loca H alth Dis+ric#. r (Signed} - --- ----------- =�✓ ----------- ------- -=nF---------- t��+�for Contractor) ` By:------------------------ --_-------------------------- ---------- -------------------- ------------- - ------ ------- (Plot plan, showing size of lot, location of sys+em'in r tion to.w�Is, buildi s,_e+c., can be placed on reverse side). FO DEPARTMENT US ONLY APPLICATION ACCEPTED BY------------------- ---- '-- ------------- ----------------------- DATE--------------- ! -_.-- ------------- REVIEWEDBY------------------------------------------------------------ -------------------------------------------------------- DATE--------------- ---------- BUILDINGPERMIT ISSUED-------------------------------------------�}------------------ ------------ ------ DATE---------------- ------------------------------------------- Ai+erations and/or recommendations:- _.1D_- -�/�' - - �_ _ _�---- -------------------------------------.------------- ------------------------------------ ' -------------------------------------------•---------------------------------------------------------------------- •---------------------------------------- ------------------------------------------------------------------- FINAL INSPECTION BY----------------------� /�/-- .-_�-. --� / � ----------- Date-------- � _ ----------------- SA ---------------- SA JOAQUIN LOCAL HEALTH DISTR 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CD.