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R�v - -------------- Jeg, APPLICATION FOR SANITATION PERMIT Permit No. ------ -------------------------------------------------- (Complete in Duplicate) Date Issued -------- ----------------------------------------------W W=W M=W E W W W. I This Permit Expires I 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 Ordinanc No. 549. Z . ...�. ------------------------------------ JOB ADDRESS A7 OZ.... ON. &1291, S`cZ' .. -------- .......... Owner's -- - -- ---------------------------•--.......••----.... Phone........................—...... -------- --------- ............................................................. Contractor's Name.............. -------------------------------------------- .................... Phone.._.....---------------- 1�> 1;< - i Installation will serve: Residence Apartment House [] Commercial C-] Trailer Court E] Motel C] Other [3 Number of living units: Number of bed rooms'vZ Number of baths Lot'sie ---- ............... j , - Water Supply: Public system ff3"�Colmfnun�ity system l0: Private D�'Depfh to Wafer Table 5.�5 ft. Character of soil to a depth of 3 feet:i Sand 0 Gravelb Sandy Loam 0 Clay LoamtEl Clay [3 Adobe Er'4ardpan D Previous Application Made: (If yes,da"te--------------------), No 2--"New Construction: Yes [I No [-] FHA/VA., Yes 0 No C1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -pt c an6 Distance from nearest well-----------------Distance from foundation---------------_--.Material....--...._....-__._...._._.._._......_.......... to No. of compartments--------- -•--------------Size--------- ---.•---,Liquid depth....------------------Capacity....................... 014 Disposal Field: Distance from nearest well_ �- -- Distance from foundation---Id..*......Distance to nearest lot line...-6........ 94--' Number of lines------- ....S---M----------Length of each line-,?,O-------------- Width of trench.........2-in-.71'r..j..._...... Type e-1 a y e of filter materia lr--Depth of fil -Tot I length------------------3.Q Seepage it: Distance to nearest well;- --------Disfar,6 m un ation--- ........Distancq to nearest lot line--.,s----- P7-- Number of pits--------/------- I LiKing material_ --Size: Diameter-----33---------- Depth------- --------------- Cesspool: Distance from nearest well------ ---------Di ante fro oundation--- --------------Lining material__.------. -----------------•- �j El Size: Diameter---------------- ------I---------------Dept ------ ............................Liquid Capacity----------------------------gals. Privy: Distance from nearest welIJ----------------------------------------------Distance from nearest building.-__----_--_-_---___--____-__-.-.---.-.-.. ❑ uilding----------------------------------------- F1Distance to nearest lot line-.t------------------------------------------------------ —------------------------------------------------------------------------------ IT Remodeling and/or repairing (describe):-------------i--•..................................................................................................................................... ---------------------------------------------------- ------------------------------- i.......m......................................... ------------------------------------------------7---------------------- 4-------- ...............................................%1k- ----------------------------------------------- ----------------------------------------------------••-•---•--...._---•------------•------------•------------------------------------------I--------------------- -------------------------------------------------- I hereby i y that I have prepared this-applicAf ion and that the work will be done in accordance with San Joaquin County ordinancet,hereby aws, and�r*s end rerulationi of the.-San Joaquin Local Health District. .4 A"L�� % ..............7 . ....... .. ........................... and/or Contractor) (Signed)...... . ....................... .. --- ------- ----------------- -(Title)---- By:--------------------------------------------------- --- --------------------------------- ................ -------------- (Plot plan, showing size. of lot, location of system inrelation to s, uildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-�-, ------------------- DATE-------. ------------ REVIEWEDBY------------------------ --------------------................................................... ............. DATE-------------------------------------------------------- --------------- DATE------------------------ ---------------- BUILDING PERMIT ISSUED.��----------------------------------------------------------------------- - "�fn. - ---—-------- Alterations and/or recommendations:-•.-' -------� -------- F -- -U <�------- �:L'a-------•----------- ------- --------------- ------------------ --.... .--•--........-.------------•-------------•------------- ----------------------------- --------------- --------------------------------- ------------- ----------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------................ ----------------------------- --------------------------- -------------------------------------------------------------------- ------------------ ------------------- ---------- FINAL INSPECTION BY: Date---------3; ---------------------- SAN ---W----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 eM B-61 ATLAB