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FOROFFICE USE: ------------------------------ -------------------------- -------------::------------------------------- -------------------------'-------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....�cF�._.3 .., -------------------------------------------------------- (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 constr ct and 'n all the work erein descri ed. This application is made in compliance with County Ordinance No. 549. �� d-" JOB ADDRESS AND OCATION_______. - ---------------------- - / Owner's Name = ----------------------------------------- Phone.-------------------•--------------- Address0I � �3 ------------ � 1 //' Contractor's Name-----/ 1--- 1410-_------------------------------------•--•-----------'------------------- Phone_7^�__.----------------•------- Installation will serve: Residence, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. __�-- -- Number of bedrooms _)?_'___.Number of baths _Z.____ Lotysize ____s.5_ ._ t'2er��__________________ Water Supply: Public system ❑ Community system ❑ Private Depth to-Water Table /J_ ft. , ,4 Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam I] Clay [] Adoba,6 Hardpan F]Previous Application Made: (If yes,date--------------------) No New Construction: Yes No ❑ FHA/VA: Yes ❑ N3�< i V I TYPE OF INSTALLATION AND SPECIFICATIONS: - { (No septic tank"or cesspool permitted if public sewer is available within 200 feet.) 6' I Se ®c Tank: Dtance from nearest well____-.- Distance from fundation_____- _ ____.Marial- lve oQ -` T --------- Liquid --__-- Li uid de th___5� ---------�;No.,of-.com artrents______ Ca acit e_`4;2 ---6it Disposal Field:. Distance from nearest weil____S�- Distance from foun.4ation._-.lb.-F_---.Distance to nearest lot line___- __�_____. Number of Imes'" .W____�i" Leµgti.`of�each�i e= ~"/: _______.Width of trench 2------�_____________ �. 'of-filter rnafbrial_,5_ _Depth of filter matenal_______��__-'.Total length__________ _ ___��l.� --------- Type age Pit: Distance to nearest well__-----.<...�-------Distance from fo dation______._.___'.___.Distance to nearest lot lin ------------ Seep' .- ❑ Number of pits------- -----;Lining material"" "Size:�.Diameter--------- ------------Depth--------------------------------. I W � T Cesspool: Distance from nearest.well------------_----Distance from'foundation_----------._--------Lining material-------------------------------------- M ❑ Size: Diameter =_ Depth�#f - _- -- -- --- Liquid Capacity-----------!---------------gals. < Privy: - Disic�nce.,from.oe._arest,well -- _Distance from,nearest'building------------------------------------------ ❑ Distance to nearest lot line 1 .t P I Remodeling and/or repairing (describe):--------- L '`-=------------- -------- --- r ---------------------------------- - Y , F a _ t --------- --- I her6by certify that I have prepared this application and that the work will be"done in accordance with San Joaquin County ordinances, State ws, and rues and regulations of the San Joaquin Local Health District. (Signed) j- ----- - ----- --------------=------------------- Owner and76r. Contractor) --- -------------------------------------------------------(Ti#le)----- = ' (Plot Plan 'showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------------- - - ------------ -------------------------------- ------ DATE-- ------- ------------- -------------------------------- ! - --------------- - REVfEWE6 BY-----------------------------------------=-- --------- DATE-%----------------------- -- BUILDING PERMIT ISSUED ---=------•--------------- -----------------`----------= ----------------------------- DATE---- ----:--------------- ------=-------------------------- Alterations,and/or ----------------Alterations•and/or recommendations:----------------- - - ------ --=-------------- ----...--••--------•--------------------•--------------i------------------------•------------------------ ------- ! fi + t c -------------------•---------------- ------------------------------------------- --- ----- - i - --------------------------- --------- -------------------------------------------------------------------------------- --------- � . FINAL fNSPECTION BY________________ ___.________: -- / Date • SAN JOAQUIN LOCAL HEALTH-DISTRICT _ 3 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 6-59 3M 3-'63 f.P.CQ. -„ _ A