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f 17�xU� -L USE: ---6-- ----------------- --------------- --------------- --------------------0--------------- APPLICATION FOR SANITATION PERMIT Permit No ---------------------- - --- ---- --------- (Complete in,Duplicate) I ----------------- Date Issued �-------4- (13 .4 This Permit Expires i Y"r4roqn.A)604 Issub'd, -- ------------- I Application is hereby made to the San Joaquin Local Health District for a petmit to c'. This application is made in compliance with County Ordinance No. 549. on'ttruct and install the work herein described. JOB ADDRESS AND LOCATIOWPIZ--- ------ _-liz Owner's Name- 06 ---------------- ------------------- jo --- ----------------- -- --------- Phone------------------------------------ --- -------------- ---------- Address-------- ------ .......0� ------ ...................t-A------------------------------------------------------ .................... Contractor's Name------ --------------- • ------------- I— *�---------------------------- Phone................. Installation will serve: Residence Apartment House ❑ C moe I Ii. � ............ 0 om rcia e' Tr,4iler Court F] Motel E] Other El Number of living units: -/---- Number of bedrooms --- Nu4&er of' at - -/ - e,r", C,-?- hs Lot size ---7---- ---- Water Supply: Public system F --- ---------------------------------------- Community system Ej Privatelif" Depth,i Water Table/0- ft. ,e I Say Loam M Clay Loam Character of soil to a depth of 3 feet: �&n4Q vel ❑ Previous Application Made: (if yes,date___-_.._______.__)' ❑ Clay Aclobeg Hardpan E] No New I Ilion: Yes;< No [_1 FHA/VA: Yes El No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if}public sevsql;js,1avaiIabjg,wifhi 200 feet.) 'i 20' ffi in ance. u _,,_4-------------------- or ---- ---------K Septic Tank: Distance from nearest well'-��2i4-------Dist"*� roN t _n ion--- 4at" S_ C; No. of compartment------ . ............ Size�� Liquid depth_-- Disposal-&*W- i' ---Capacity-,11 _ Distance from nearest well.�5_4. ......Distance from fou ation -4�----------Distance to nearest lot line-340 Number of lines________..____�/ c -,I- - --------------_ --------Length of each 1�iine_�_ -- ---------------------Width of trench.-/46-- Ff Seepage Pit: ------- Type of filter material.. . . ---Depth of filter material__ --::Total length-------------- Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-_-__..___--/ 171 Number of pits_.-__._"-__"-________-Lining material-.-__"._-...__-_------ Size: Diameter-----------------------Depth--------------------------------- Cesspool: ---Distance from nearest well___-"-_-._-_.___ Distance from foundation--------------------Lining material_-________"--.----_.___.________-._-_. --- Size: Diameter----------------------------------Depth--------------------------------------------------Liquid Capacity-----------•---------------gals.. El Privy: Distance from nearest well______________"-_."__.____.__-"--------- _ Distance from nearest building------------------------- Distance to nearest lot line ---------- ----------?�D� ------------------ --------------- ---------------- Remodeling and/or repairing (describe):___Gt?� ------------ ------------------ �e---------------______---- --------- -- - ------------ ----------------------- ---- ------------------ ---------------- -------- ----- --------------�,/-- ------ ----------- --------- -------------------------- ------- ----------- ---- ------ ----------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------I----------------------- I hereby certify that I have prepared This application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--r_ ------------------- - --- ----- -- -,4---- -------------------- - ---- -(Owner and/or Contractor) By:---------- t/ ----------------------------------------------- e—e- (Plot plan, showing size of lot, location ----------(Title) ---------- ----------------- - ---- -------- on of syt em in relation to clings, etc., can be placed on reverse side). FO PARTMENT USE ONLY APPLICATION ACCEPTED E -------------------- DATE--------- -- ---------- -- ------------------ REVIEWED BY ----- -- ---- -------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED---------------------------- ------------------------ DATE Alterations and/or recommendations: ------------------------------- --------------------------------------------------- ---------------------- ----------------------------------------------- -------I-------------------------------------------------------- ----------- ---------------------------------------------------------- ------------------ -------_------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- -------------------------I-------------------------------------------------------- ----------------------------------------- --------------- ------------------------------ ----------------------------- ---------------------------------------- ----------------- --------------------------------------------•--------------- FINAL --------------_-----------FINAL INSPECTION BY../,� . . ...... ------------I Date. - SAN ate--- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 sycamore Street Stockton,California Lodi,California 205 West 9th Street ES 9 REVISED 8-59 3M 3`63 F.P.120. Manteca,California Tracy,California