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� -/ORR OFFICE USE: �`--------------------- G1 ----------------- - ---- _-#•_ o_ APPLICATION FOR SANITATION PERMIT Permit No. ._.1..'J�_ � --------------- -------------------- -- (Complete in Duplicate) S 041 - �11 - Date Issued ______ _____________ ....................... 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..549. JOB ADDRESS AN LOCATIO ._..�__�...(�_ ------------------------------------------------------------- l � "0 Phone Owner's Name - 7a.4!�o --------------------•-------------------------------- - ----- Address----------•----------•-- --•--•--�d.a.. .F - -------------------• -----. ------ Contractor's Name...------...0:. •--- . -?t� ----------------•----••--------------•--------•--••------•--•----•-•----•---•---- Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 171 Number of living units: ---/. Number of bedrooms. Number of baths J.._. Lot size ; -P ......... Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table 6 t. Character of soil to a depth of 3 feet: : Sand ❑ Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay E] Adobe ardpan El Previous Application Made: (If yes,date-----------_--------) No -New Construction: Yes E?-5o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �J Septic Tan Distance from nearest well....!?=.Distance from foundation-Q_/......MateriaC(<__ -----� C.4---------- No. of compartments- �--- Size._._.3' �X (�:._.Liquid de th__-"(1//2.•t__._-_- Disposal Fi Distance from nearesf well____. .___-Distance from foundation___ _ ,� �4e}� / � Distance to Weare. 'lot line................ Number of lines________________ Length of each line....._.-.''J_.Q_ _._________.Width of trench .'l�______-________-_-__ T i � $ W Type of filter material.._�_��ac�Depth of filter material_, .__4--_-._Total length_______ „_�--- ------------------ Seepage Pi Distance to nearest well---.-._-----�_-----Distanc from foundation-IQ._ .......Distance to nearer lot line.. Number of pits.._._____...._._Lining material_ er�.____--Size: Diameter-., j_i/_._-.._.Depth_.q . ---h-- _ Cesspool: Distance from nearest well-----------------Distance from foundation-----------.--------Lining material-------------------------------------.7 ❑ Size: Diameter--------------------------------------Depth.--------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-__---.-__-___-_-_.---______-_--_---.-.... ❑ Distance to nearest lot line--------- -------------------------------------- -------------•---------•---------------------------•-----•----------------------------------- 0 Remodeling and/or repairing (describe)--------- - -4--o-------- ----- -------- -------=-- -'t -------- --.................................................40-p-P ------------------------------------------------------- ---- ------------------------------•---------------------------•-------------------------------------.-------------------------------------•--------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I havVpre red this applica+ion and +hat the work will be done in accordance with_San Joaquin County ordinances, S+ laws, and rulregulations of the San Joaquin Local Health District. (Signed)------------- �- - - ------ -- - -------------------------------------------------------------------------------- ------(Owner and/or Contractor) , By:.......................... -�--- •----- - - - - - ------------------------------------------------------(Ti+le)---- - ------ ----------------- -- ------------- (Plot plan-showing,showing size f I , location of syr+em in re ation to wells, buildings, etc., can be placed on reverse sl e. FOR DEPARTMENT USE ONLY ��/ APPLICATIONACCEPTED BY----------- ------------------------ ---------------------------------------- DATE-------` -` --------------------------- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------- — DATE----(-------------------------------------- -------------- Alterations and or.recommendations � (< < - t.___._---- ... ._ _ .._.�_� -S .... --- --� ��r ----- ----- - ' ,. ------------•---•------------------- -------- -------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- -- ---------------------------------------------------------------------------------- -----------------....... -------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:--------- --------------------------------- Date----- "—`2 ------------------------------------ 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 CS 9 REVISED 8•S9 3M 3-'63 F.P.CD.