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FOR OFFICES ✓ ,. APPLICATION FOR SANITATION PERMIT Permit No . ........................ --------------- (Complete in Duplicate) '� ' This Permit Expires 1 Year From ,Date Issued Date Issued .... I 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 Ordin nce N 44. JOB ADDRESS AND LOCATION_... 1_. _A� - - -- ---- •• Owner's Name------ Y .... •-=�--- . ---------------------=-------------- Phone---- --•---------------------------- ---------------------------------------------------------------------------------------------------------- r l Phone Name - Installation will serve Residence [?Apartment House ❑ Commercial ❑.:.Trailer Court ❑ Motel ❑ Other ❑ Number of living units:.______ Number of bedrooms �__ Number of baths ___�__. Lot size_____t..,r1_�.� ------------- _-------- Water Supply: Public ,system �Corimmunity system ; Private ❑ ;Depth to Water Table ° ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®'Hardpan ❑ f Previous Application Made:' (if yes, date ----------- ,--------- ) No ET-- New Construction: Yes IVO ❑ FHA/VA: Yes ❑ No Com~' TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tati:k or cesspool permitted if public sewer is available within,200 feet.) Septic Tank: Distance from neatest well ---- Y2?ie_ Distance frompoundation._____/_v_____.Material_________ P -- . ` No. of compartme ts--------Z_-__--,----_ Size-------- __�Y �',dc�r--Liquid depth -----A- -------------Capacity____,F-_-Ci/__ r.Y Disposal Field: Distance from 'nearest well ---- i�L,D.istance from'!foundation_,l�__r__.____-Distance to nearest lot line ----L--- i c Number of lines. -_. h line ---------- 0! -------- t:__c:�_y_ Width of trench-_________`______________ .____- .�_:___ Length of each Type of filter _; Seepage Pit: of filter material__/_y____________Total length ------ �2_'---------------------- ___ p g Number of i are j ell_---_-71_______D•sstance m foundation___./o_-_---..D'sstance to nearest lot line_______________-_ C7 e P t: Distance f nearest w Lining material- _c� __Size: Diameter. ___ .___- Depth_.-.? ------------------------- Cesspool: ---____________________Cesspool: Distance from nearest well -------- __ ----- Distance from foundation --------------------- Lining material ____-_-_---.__________________--___-_. ❑ Size: Diameter____` - Depth------ .------------------- -----------#____Liquid .Capacity.- .................... gals. Privy. Distance'from nearest well -__-_--F--___-4_____________________ Distance from nearest building_______:---_--_--____________-_____----_. ❑ r .. ..�. - . -.------,_ ---------------- ----------- ------ ------ ------------- Distance to nearest lot line ----------------=----------------------- - - -----•----.-•-----_-- r < Remodeling and/or repairing .(descrihel___________________________________ _----__-- --------------------------- --- , / kti y } a ----`----------------------------------------=--------------------------'----'---`----------------- -------'----------------------------------------------------- I hereby certify that I have-prepared'ihis-application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a`r ulations of the San Joaquin Local Health District. 1 (Signed)-. ------------------------ ---- --- ---= --- r---- -- ---------------------------------------------------='-----------------------------------(Owner and/or Contractor) --------------- By: --- -------=--= =-------------------------------------------------------- :{rtle) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). ..a. y,. A+ - �....o..„.,. y.. - l - m _ F�OR'DEPARTMENT USE ONLY ) • +4 ti/ - APPLICATION ACCEPTED,�Y. '-- --amu-- -- ------------ ------------------------------- DATE ---- �---•-'-----•---- �-0------------------------- REVIEWEDBY ---------- --------------------------------------- `bATE----------•-- •----------- -------------------------------- BUILDING PERMIT ISSUED --------------------------------------- DATE-•--------------•------ - --------- -------------------------------------------•- • ------------------------------------- Alterations and/or recommendations: ------------------ - _______________ __ �____�__ ____ -- ----- = f -- .� -- -------------------- ---------------------•-•---•----------------------------------------- ------------------ 1----------------- --- Date- � ` 6-� (` -------- FINAL INSPECTIONi BY-.-=-/.�,r-t��.- ----- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lad], California Manteco,'Callfornla Tracy, California E8•9 REVISED 19.59 F.P.CC. ZM 6.60