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FOf FICE USE: f --- APPLICATION FOR SANITATION PERMIT _ (Complete in Duplicate) Date Permit Issued . ' - _ _ � .--_ -_- 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. JOB ADDRESS AND LOC T10N �y� � lel � ii ------ ----�- ' Owner's Name_._ ---- --------------- Phone__ Address__ `------- ----- ---- ---------------------#' r ;-- % f t ' r 3 ------••------ S S '-- -- T - - x Contractors Name ' ' c.G- �� i -i------- :..... . ---- Phone. Installation will serve: Residence "Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�---- Number of bedrooms _ _- Number of baths 3_.-- Lot size .1�'rr_9._Z44n---------------------- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table -&, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [n.—Ciay Q Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date -------------------) No PT" New Construction: Yes ❑ FHA/VA: Yes No ❑ TYPE: OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weh ._....Distance from foundationd.�- ---------__Material_ Size ' ----'----��- -------- Liquid depth . Capacity-/,.4--? No. of compartments-_ _.__ --._. ....__ f'._=i__1_ Dis osal Field: Distance from nearest we!I_"'--------Distance from foundation.A�.............Distance to nearest lot line~'_f___ -_---- p Number of lines___.•�.-------------- Length of each line--4.e'----------------_-_Width of trench__ .. -----------------_ ----- Number c. Type of filter material��' _...5_.._.._Depth of filter matenaL_/.S'__-__-__._____Totallength----LL-z---------------------------- Seepage __________________________ f SeepagePat: Distance to nearest well .___..�-----------Distanceom for dat�on__/n--------- stance to nearest lot line.,-5 ----------- A Number of pits._. ---------....Lining material..._n.(.!._ Size: Diameter-._D _ _. ..... Depth- __ �- �___._.____ Cesspool: Distance from nearest well.................Distance from foundation. ----------....... Lining material_ 0 ❑ Size: Diameter------------------------- -- --------Depth--------- -------------------------------- --------Liquid Capacity-- - - -------------------gals. Privy: Distance from nearest well-------------------------------'--............---Distance from nearesf building_....'---------------------- ---------.. ❑ Distance to nearest loft line- ------ ------ ----------------- -- ------------------- ----------------------------------------- - - ---- - -- ---------- G Remodeling and/or repairing (describe):-------- ------- -- -------------------------------------•-------------------------------------- ------- ----------------------------- --- -----------------I----------- - -------------------------------------------------------------------------------------------------------------------------------------------------------------------- - __ �- ----- '----- - ------------------- ----- ------- --- ------------------- ------------------------------------ ------------------------- -------...-----...-------------------------------- --.-- „+ i accordance with San Joaquin County I hereby certify {hat I have prepared this application and that the work will be done n a q Y ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------------ - - - -- - ------ --------------------------------------------------- ------ ------- -- -------- -------------- (Owner and/or Contractor) 1 By: ----- � (Title)---- - -- ------ (Plot plan, showing size of lot, location of sys%m in relation to wells, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY cvY 7—� DATE-------- REVIEWED :-._r___ � .-/ APPLICATION ACCEPTED BY---- �--- -------- ----- _' _ REVIEW ED BY ---------------------------------- -----'-'-. f--- --- --------------- --------- '--------- ----- DATE-'-'----'-'-"-'- -------------------------------------- BUILDING PERMIT ISSUED----------- " - ---------- -------------_---... DATE z Alterations and/or recommendations.__.;.. x7_:..�._ :. .. r� z�__ .:_1 . ='= ` `f`-----`---`--=-------= Ems: ' '�' "--------------- -r. ------ ' --------_----- - - -- - ------/ ..-...�_...Z_�------------------------. 1�"r f--'--. ` �� ----- --------- ------------------------------------------------------ --------------------------------- ------- - ------------------------------ ------------ ---.------------------------'--------- '--------- -------- ------------------------ ... FINAL INSPECTION BY:._`:.'`.,%.;._ 5 '/ J -.� L... Date /' C SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California ES 9 REVYSEO B-59 31A 3-'63 F.P.00.