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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT Permit No. .......,71- __ --------------------------- --------- a(Complete in Duplicate) F � Date Issued ---- ----------------------------------- --- --I---------- --- 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. , I t JOB ADDRESS AND CATION!_V`___ _, __`__ _1�-- ----------------------------------------------- --- -------* '10 tS-3 Owner's Name---- - - ` Phone.. l T IF Address --------- ---------------.------ -------------------- °---------------------------------------------------------------- •---••----------- i Contractor's Name - -------------------------------- #--------- Phone_G/KG_-70�_ Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ . Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/--- Number of bedrooms 0--- Number of baths __e "_ Lot size ` l - ___________.____ Water Supply: Public system ❑ Community system ❑ Private.9_Depth^.to Wafer Table4� ft.: Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ ,- Sandy Loam ❑ Clay Loam ❑ ClayXOclobe❑ -Hardpan ❑ Previous Application Made: (If yes,date------------------__) No ❑ New Construction: Yes ❑ N0 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer'is available within 200 feet.) i nk: Distance from nearest well------_________Dis#ante from foundation______.___________.Material_____________________--- -._c________.__.._. No. of compartments------- ---------Liquid depth---------- - -------------capacity------------=------ t :.r_ I ss e�tl: Distance from nearest well-,-IS a .`._.Distance from foundation---1/L1_. .__.Distance-to nearest lot Number of lines__________________ Length of-each line__-_-�-�__-_'_.__-------Width of trench-__._,v�_'j-_ ---_------------- Type of filter materialS� -________ _Depth of filter material____._,,�___fl____..Total length______ ____z�__s4________._ . Seepage Pit: Distance to nearest`welt/Q- ------------Distance fr m fo ndafion___s l-?_.._-___-Distannce to nearest lot Number of pits.__.____.__`"__Lining material"Size: Diameter._. ---_-____-" Depth-----__e ------___-_____"_.___ Cesspool: lir 5 Distance from nearest'well-----------------Distance from foundation------------------- Lining material___.___________________.___________- 'r Size: Diameter--------------------- ----------------Depth- -------------------------------------------------Liquid Capacity- - ------------------------gals. Privy: Distance from nearest well----------------------------------- -------------Distance from nearest building------------------------------------------ F1 _________.__.__________________..___.._.❑ Distance to nearest lot line-------------------------------------------------------------------------------------- ------------------------------------------------------ Remodeling and/or repairing (describe):------- -------- -_1---------------------------------------------------------------------------------------------------------------------------------- ` a --------------------------.•----------- ----------------------•---------------------------------------------------------------------------------------------------------------------!---------------------------------- ----- -----------------------------------------------------------------------------------------------•---•-----------------------•--------------------••---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, VaRe laws, and rules and regulations of the San Joaquin Local Health District. (signed} (Owner and/or Contractor) J/ BY: .r�- (Title) ' (Plot plan., showing size of lot, location of.system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -- ---/ ;-------- - -- _ --------- DATE- dIk +.__ REVIEWEDBY--------------------------------------------- ---- ---------- ---- ---------------- -- -----. DATE----------------------------------------------------------- BUILDING PERMIT ISSUED---------------------------------------------------- -----,DATE------------------- ----.------------------------� Alterations and/or recommendations:-_-__--- _,� � _ _ -_________1� __ _`_ �. «- �� --------------- ~ = �- ,�-� � �a4 r2 t <------- --------•---•--•--------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ------------------------------------ ------------- -------------- --------------------------- •---------------•---------------- --------------------------------------------------------------------------------------------- /�''��'' r FINAL INSPECTION $Y:. �/4 Gy" �- Date - = S, N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 MrV15ED S-59 3m 3-'63 F.P.CD. ,