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FOR OFFICE USE: ------ --- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ........................ 3 -- --------- ------ 4A (Complete in Duplicate) r / G�`"" ® Date Issued ---- - _ This Permit Expires 1 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, I This application is made in compliance with County Ordinance No. 549. / I , JOB ADDRESS AN L DATION �7-�`-----`h---- 1L UP �.'�c- ' e( �`'-rte : - ------- -------------------- Owner's' ame- rN/Jf "� DJ�r JO SS --- -------- Phone c Address------------ ---�_. --•-------- --------77------------------- -•- - • ---^-------------------------------------------------------------------......... Contractor's Name--------- r Phone Installation will serve: Residence I Apartment House EL Commercial❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/--- Number of bedrooms _- Number (if baths !7�� Lot size __-___ �k t Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑- Gravel ❑ Sandy Loam ❑ Clay Loam 9__Clay ❑ Adobe E] Hardpan ❑ Previous Application Made: (if yes,date--.'-- .'.�._-_'.1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted. if'public sewer is available within 200 feet.) Septic ank: Distance from nearest weil_:-1-_$ ------Distance from foundation_____-----_______ Materiai-----_1(?__en.,,c ------------------------ No. of compartments:t___ ___ __.__-__Size_ -'i r�� ,�'X_S�.Liquid depth_______ ______ --------Capacity____ Dis os I Field: Number froof lin nearest well-----Sq-_ Len the fromec foundation---- b_f.......Distance to nearest lot line__$_�___.._.. N p ' �--�Diytance from�f'line a ¢ Width of trench. y 9 Type of filter material`___ _ -_______Depth of filter rnateriaL"'-�Q _______Total length--- � ________________________"_ _ Seepage Pit: Distance to.nearest well_--------------------Distance from foundation--------------------Distance to nearest lot line--.----------- I El Number of pits_..'"------------------Lining material---------------_------:Size: Diameter-------------------_-_-Dep+h-- ------------------------ --- Cesspool: Distance from nbarest well-----------------Distance from foundation--------------------Lining material -- Dfh " Size: Diameter-------------------------------------- e ---•---------- --------- Liquid uid Csa aci gals.�p Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----_-_._.----------------_------------- ❑ Distance to Nearest lot line--------------------------- ----------------------------------------------------------------------------------- --------------- Remodelingand/or repairing (describe):-------- ------------- - ------------------•-•-•--•----------------------•----------------------------•------------------------------------------------ - ------------------------------------------------------- ;-----•--------------•------=-------------------------------•----•--- --- --------------------------------------------------i ---------------9M ----------------------------------- I hereby certify that I have prepared this application and the+ the work will be done in accordance with San Joaquin County ordinances, State law and rules and regulations of the San Joaquin Local Health District. ______ -c (Signed)-•-----------"--• --- ---••------••--------••i--- - - --------- -------------------------------------------------------------------------.�.... .er and/or Contractor) ; (Title)_ '(Plot plan, showing size of lot, location of system in relation o wells, buildings, etc., can be placed on reverse side). t t FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY------ _ --- - - - ----- =--------------------------------------- DATE----�-- ®- _4 ---- ----------------------------- REVIEWEDBY---------------------------------- --------------------------------------- DATE------------ ------------ -----•----------- ---------------- BUILDING PERMIT ISSUED ----------------------------------------------------- DATE Alterations and/or recommendations:------------------------------------- - ------ ---------------------------------------------------------------------------------------------------•----------- ---- _ __ _= --------------- -----------------------------------------•--- ----------------- ------------------------------ t ----------------------------------------------------------------------- - - ------"----- --------------------------------------=------ -------------------- --- -------- ------------ ----------- ---------------- --------------------------- ---=-----•---------------------------------------------- ------- ------------------------------- - ---------------------=----------- I FINAL INSPECTION BY:- ^-' -� Date / 4l _------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Ha:eltan Ave. 300 West Oak Street 124 Sycamore Street Y 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F�P.CD. .