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7,7FOROFFICE USE: q2- �1 ____.---_-____--_---__ _----_---__.-_--_ APPLICATION FOR SANITATION PERMIT Permit No. ._lr� .... ------- ----------------------------------------- (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 construct and install the work herein described. This application is made in compliance with County.Ordinance o. 549. a JOB ADDRESS CAT �Mii• --- ---------�..... 0-- 'e. A LOION -- Li��.sA� Owner's Name. ------... ' - --•- •- ---- �r Ph0 Address---•7,X-d--•----- - ---•- �/ • • ..... =l - ------- Contractor's Name-------- ---- �,eL�fGsP'. -•. •------- ---- /� nCaR� Phone... Installation will serve: Residence Id Apartm nt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ---/••-- Number of bedrooms J" Number baths .--,---- Lot size ----.._...' l-�✓-'�---------I----- "aJ . v Water Supply: Public system E] Community system E] Private De;,Clay o Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----.------------_,) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTAL.LAT1IIlil-ANn ccFS1FIr,gT! tic• (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well___'_✓�_O_/-_-_Dist c;e from foundation----.f,P_.1......Material-------- ....... No. of compartments----- - ------------ � Liquid depth........��-.-_-_ Capacity.... DisField: Distance frotn nearest well _._-60. f Distance from foundation.....Jll....Distance to nearest lot (in�e.SQ• s. _ Number oflines_-_-----____!Yn____------------Length of each line________8` _.i,_.--.-.Width of french____...a ,..X----------------- Type of filter mate ------Depth of filter material----- ------Total length-__ ____________ c- Distance to nearest well-,,._.r ----------Distance fr foundation...../V�_.•...Distance t9 nearest lot line-___.�------- ❑ Number of pits----- ._..._::_Lining material__ _____.Size: Die rr+ei�er---�,_.YLP_..Depth_______ ___________________ Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material--------------------------------------- 171 ----_- ___--.--__-_-__---_-__-_--_-.❑ Size: Diameter---------------------------- ------Depth----------------------------- ----------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- i ---_:_ _,_-_._- ,-_-_--_----_-----. ❑ Distance to nearest lot line----------------------------------------•---------------------------•-------•----•-----------------•-----•------------------------------ - Remodeling and/or repairing (describe):- - -------------------------------------- ••--------•---------•-•-•--•---------------------- ---------------------------------------------- -----------------------•-------------------------------------------------------------=-_ ................................................................... -------------------------------------------------------------- ------------------------------------ --------------------------------------------------------------------11-----------------------•----;---------------------------------------------------------------------------------------------- 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, a ru sand regulations ofRn Joaquin Local Health District. -.(�wj/ r on roctorJ (Signed)-•---------•---•-•--•-•--------••••. --- -% , ---------- o C tBy:........-•----. •- 3 - --------- ifle)---------_- -- -- -(Plot plan, showing size of lot, location of system in to we , buildiings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --- ---•-- ------------------------------------------------------------- •-•--------- DATE, _A_'/-- - -----------------------------•---- REVIEWEDBY--------------------------------------------- --------------------- --------------------------------------------------------- DATE------------------------------------------------------------ BUILDING_PERMIT ISSUED--- -------- -----------------__------------ ------.- _ ------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations---- ------------------------•--- ----- ---................................................................................................... -------------------- •----- ------- ------------ ------------ -----------------------------------------------•---------------- ............................................................ -----•--------------------------------------------------------- FINAL INSPECTION BY:-._ sa�j___--_____________________ Date...x; __oT`-------- 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 8-59 314 3-'63 F.P.CD. �`'