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FOR OFFICE USE: -------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------- (Complete in Duplicate) 4-71-o -------------- Date Issued 10,..13i-496 ------------------------------------- -------------- 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 AND LOCATION49 ••- '+ - --- Owner's Name.----_.1.... --A--. . .................................... ----------- --------------------------------------------------- Phone----------------------------------- --------------------------------------------------------------------------------- Address---1:2/19P. ---..s.... ...................... .............*-------------- Contractor's Name.........1� -�— ....... ....................................................................... Phone................................... Installation will serve: Residence 7Apartment House 0 Commercial E] Trailer Court [] Motel 0 Other 0 Number of living units:- -/......Number of bedrooms 3.. Number Nurnbbaths I .4 --- Lot size .. �... --------------------- Water Supply: Public system [] Community.system-,,Q Private ��Deptht Water Table ........ ft. Character of soil to a depth of 3 feet: Sand 0 Gravel F] Sandy Loam Depth Loam 0 Clay ❑ Adobe 0 Hardpan 0 Previous Application Made: (if yes,date----------- --------) No ❑ New Construction: Yes El No C] FHA/VA: Yes E] No El 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--------------—Distance from foundation....................Material-___---_.____..__..____, .... El No. of compartments..-. ..------ ---------Size................................Liquid depth--------------------------Capacity....................... Dispose�/fielcl: Distance from nearest well.---5;!!.......Distance from foundation.....4V---------Distance to nearest lot line—�........ I........... -2--/ ------- 1W Number of lines_.........1__- -- Length of each line-----4VAP---- Width of trench................7........... Type of filter material-___._S 7 .1-----------Depth of filter material......1-9..........Total length......./-O-iv........................ Seepage Pit: Distance to nearest well ...................Distance from foundation--------------------Distance to nearest lot line...._______...... ElNumber of pits----------------------Lining material...---------- ---_-----Size: Diameter-----------------------Depth-_-----._ _---.----.---------- Cesspool: epth--------------------------------- Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material__-_-_-___.__ -____-----. ❑ aterial-------------------------------------El Size: Diameter-------------------------------------Depth------------------------_------------------- ------Liquid Capacity---------- --------...gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):- --- - ------------------------------------------------------------*---------**-----------------------------------------------*------------------- ............................................................. ..... ...........................................................I-------------------------------------------------------------- .............................................---------------------................ ---------------------------------------........................................................................................... - ------------------------------------------------------- .......................---------•----•----•--•-•------- --- ---•----------------------•----•---------------...... --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin 6,,ounlj�N ordinance$, State laws, and rules and regulaflons; of the San Joaquin Local Health District. (Signed)...... .... ........... D......... -------- .......I......................................... Z--.----:4M01ALand/or Contractor) BY: ...... ......2--+ vzi ------------------------------------------------------------------(rifle)---------------------------------------------------------------- L 0- (Plot plan, showing size of lot, location of s4tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 77 APPLICATION ACCEPTED -----------........................................... DATE-J.47--.Ar�nZ.-d' ....................... REVIEWEDBY------................................... ..............-................................................................... DATE............................................................ BUILDINGPERMIT ISSUED................--------------------------------------------- --------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:--------------------------------------------- ..................................................................................................------------- ..................------------------------------------------------------------------------------------------........................................................................................................ ............................................................................................................................................................................................................................ ....................................................................................I........ -------................... ...............................................................................------------ ------------------------------------ ................................... ---------------------------------------------------------------------------- ------------------------------------------------------------ FINAL INSPECTION BY:. -------------------- Date--- --------------------------- ......... 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 S-159 3M 3`63 F.P.120.