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FOR OFFICE USE: . ..... ...... APPLICATION FOR SANITATION PERMIT Permit No. ........................ ------------------ (Complete in Duplicate) 2 -o' Date Issued .....1.0 --- ----- - - - ---- ------------------ 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 Ordinance No. S49. JOB ADDRESS ANJD gL0 ..ZA )N--. --------------------------------------------------------------------------------------- Owner's Name.......... . . ..... ---------------------------------- ----------------------------------------. Phone.................................... Address----------------------- Contractor's Name--- -------- - ----- -------------------------------------------------------------------------------------------- Phone................................... ----_-------------------- 7 part Installation will serve: Residence ��tment House Commercial E] Trailer Court E] Motel 0 Other r Number of living units: ----- Num of bedroorrg,3.- .. Number of baths --?,.,Lot size . -Z------------------------------------- um Water Supply: Public system q��ommunity system E] Private E] Depth to Water Table ft. Character of soil to a d6pth of 3 feet: Sand Ej Gravel [] Sandy-Loam E] Clay Loam Clay [] Adobe 9,Ka-r--dpan 0 Previous Applidation Made: (If yes,date--------------------) No 000"' New Construction: Yes FHA/VA: Yes�-I�o E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--i!<------Distance from foundaf�-b�;t/A--- ......Material_a_e.9,e/ejr---------------- up"o- ... 10---------Capacity...ore-4:1------ No. of compartments------------- —---Size_,5XX..y_Q------...Liquid clepth__O/��Ia__' Dis eld: Distance from nearest well,e<--------Distance from foundation---/6 Distance to nearest lot p Nvinber of lines......... -1-----------------Length of each I i Width of trench.-Q..(/.............. .Type of filter material... Depth of filter material--- --------Total length---.,/,S-C.......................... See t: Distance to nearest well__.,".0------------Distance from foundation.......1-4)......Distance to nearest lot line.:5r_._11....... I/ Number of pits----;��-------------Lining mate ria ............Size: Diameter_3_?_,�,----------Deptlw;_2.r.��-------- tj Cesspool: Distance from nearest well-----------------Distance from foundation.---------------- material---------------------Z........... F-1 Size: Diameter--------------1-1--------------------Depth--_---------------------- -----------------------,Liquid Capacity............................gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------- 1-1 Distance to nearest lot line----------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------------- .e -fr� Z .y ------------- s;v . ................................................... --------------------------------------------------------------------------------------------------------------- --------------------------------------- ------------------------------------------------------------- I------------------------------------------------------------------------------------------------.................................................................................................. --------------------- - ----------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------ I hereb rfif A f I have prepared this application and that the work will be done in accordance with San Joaquin Couni T ' ' ordinances, Lcete 7�w-,aand1j9F �arnd regulations of the San Joaquin Local Health District. (Signed)-------- --- -----------------------------------------------------------------------------------------(Owner and/or Contractor) /16/0- --------- By:....................... --------------_-- ---------------------------------------- (Plot plan, showing siz__ o 6, location of system-Wirelation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY :7 2-, ?_ �------------------- APPLICATION ACCEPTED BY-------------_-4r20_e-:0,C.;-------- ---------------------------------------------------- DATE------ ----------------_. -_ REVIEWEDBY--------------------------------------------------------------------------------------- -------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED...................................-----------------------_----------------------------- --------- DATE-------------------------------------------- Alterations and/or recommendations:---------------- ------- -- ------------------- --------------------------- ------------------------------------------------------------------------ ------------------- .............1,_e4.�z----<----—----- 4-------------- -------------------------------------------------------------------- ---------------------- . .. .................... ---------------------------- --------------------------------=�_%....................................r . .. "000 -------------------- -7n Jio��-------- j9?Km -elkA-499. --------------------------------- ----------------------------------------I------------- ------ -- ---------:- -------------------------------------------------------------------------------- FINAL INSPECTION BY:............. --------- ---------- Date....... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3`63 F.P.120.,