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FOR OFFICE USE: -------- --------- --- APPLICATION `FORSANITATION PERMIT Permit No. - --------0------------------- -----------_1A._,!!7�--- - - --------- -------- (Complete jit Duplicate) Date Issued ------------ This Permit Expires /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 N 5 JOB ADDRESS AND CATION------ W_ --------- --_ - . . /Ioz�----------------------------------------------------------------------- Owner's Nam ------ ...............------------------- ------ -------------------- -------------------- Phone._..-------------------------------- Address.- . - - ........... .... . ADDRESS AND CATION- a m ... . . . .............. .... s am ....... ----------------- - ---- - ---------------------_- Phone................................... Contractor's Name.--.,::- Installation will serve: Residence 9Apartment House E] Commercial E] Trailer Court E] Motpl 0 Other E] Number of living units: _/__ Number of bedrooms 44-, Number of baths ---�_. Lot size ------------ Water Supply: Public system E] Community system E] Private1,'Depth to Water Table 4�.. ft. Character of soil to a depth of 3 feet: Sand F] Gravel [] Sandy Loam 171 Clay Loam E] Clay [] Adobe Rj--TTardpan ❑ Previous Application Made: (If yes,date--------------------) No VINew Construction: Yes E] No a— FHA/VA: Yes 0 No K}--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S�tic Tank: . Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------ A"� r� No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity-------------------_- Disposal, lepth-------------------------Capacity-------------------_- Disposal,Field.; Distance from nearest well--_ Distance from foundation. ._-----_.Distance to nearest lot line....;........... �'r Number of lines_______ee--- Length of each line--Z .,,,�7 Width of trench---- Z------- ------- ZP111#--- Jr Type of filter material. Depth of filter material---------IV------ --Total length---- I ------Distance from founJation----- D' t to nearest lot line... Seepage 4N t. Distance to nearest well____ �p W * *?� Number of pits-----/_----------Lining material--- O_It_�'Size: Diameter___� -- ----- -----Depth.4�_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-.._-.._----__--___--__--_.-.-_-_--.. El Size: Diameter--------------------------------------Depth---------------------------------------_-_._._____Li quid Capacity---........................gal . Privy: Distance from nearest well----------------------------------------------.-Distance from nearest building--__---_-_._----______-_-----.-.-.--__... V,0 Distance to nearest lot line. 171 ------- --------------------------I------------------------------------------------- ------------------- ;0001 Remodeling and/or repairing (describe):------------------- --------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------P, ------------------------------------------------------- ---------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------- ......----------------------------------------------------------------------------------------------- ------------------- -------- 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, and rul9s and regulations of the San Joaquin Local Health District. (Signed)---------------------(_A1,*--- (QW510ZZVor Contractor) - --- --------- ------------------------------------ By:......................................................--------------------- ---------(Title)----0411;7�----i--------------------- ---- --------- (Plot plan, showing size of lot, location of system in r� ion o wells, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.------ ---�7__Z--------- -- ----- ------ ------------------------- . DATE- ----------_------------------ REVIEWEDBY--------------------------------------------_------------ ----------------------------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------_-------_----------—-------------------------------------, DATE------------------ r Alterations ATE-----------------Alterations and/or rec?mmendations:----------- ------------- -__3--.---./-9��' ---------------- '.12 -A----------------------------jl,_,-.!��..�T�------- ----------------------------------------I................................... .........................----------- ----------------- ----------- ---------------------------------------------------------------- -------------------------------------------...........1-................................ ................. ------------------------------ ----------------------------------------------------------------------------------- ---------------------------------------------------------------------------.......------------------- -----------------------_ - -------------------------------------------- -------------------------------- ---------------------------•---------- -------------------------------------------------------------------------•---------- -------- �, 4 ---------- 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 8-59 3M 3-'63 F.P.00.