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FOR OFFICE USE: ----------------------- --------------------- APPLICATION FOR SANITATION PERMIT Permit No. -- ------------------- __ (Complete in Duplicate)' 7 Date Issued .4------------- ________ 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. ' This application is made ingomplia�nccee wi Cou t Ord' anc o. 549. pp 5 'ARCIP �Z m! W OF �Kl �1L�E`/ / MTc�4 vJOB ADDRESS AND LOCATION..._..-� f� ----------------------------------------------------- ---------- . f n y. Owner's Name-------•-------------••---------- 1�'.<.�— �F t-1_.R_ '� ----------------- Phone------------------------------------- Address................... ----------•------------ -------•-- Address------------------. ---- ---------------------•------------------------------------------------------------------------------------------------------------------------------------------ Contractor's Name--------- ce part-------------------------------------------------------- ---------------------------- Phone----------------------------------- t Installation will serve: Residenment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of. living units: -)----- Number of bedrooms _x._ Number of baths ---j... Lot size ----------06:,-1-: r Y t Water Supply: Publicisystem ❑ACommunity system ElPrivate epth to Water Table -------- ft. Character of soil to a depth of 3 feet: , Sand ❑ Gravel ❑ Sand Loam lay Loam E. Cla - Adobe E] Hardpan E]f Previous Application Made' (If.yes,da ----------- I No 2Ne, Construction: Yes o ❑ FHA/VA: Yes [❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'permitted if public sewer-is available within 200 feet.)` [ / ._ Septic=Tank:—��P�Distance��from nearest�weil-- -�___-Dis#ance—fram3faundation--�_ __-__----Materisi- ---------- No. _______No. of compartments----------;;Zo------------ ---:---Liquid depth-----_,- ----Capacity---- Disposal Rd: Distance from nearest well--„ ...... Distance from foundation_ ........Distance to nearest lot li ___L Number of lines_______ ___ ______ ________Length of each line h' X idth of trench------34- ___--_-._-_____. I Type of.filter.,materiaL__ _____----Depth of filter material_./--_--__._____._Total length__:__:_1`__-265__ ___________________ Seepage Pit: Distance to nearest well-----------------------Distance from foundation-------------------Distance to nearest lot line______.___._____ ❑ Number of pits.---------------------Lining material----- -----------------Siz'Di•ameter-------------------.---Depth-----------------•--------------- Cesspool: Distance from nearest.well_________________Distance from foundation- material-----_------------------------------- 3 ❑ Size: Diameter----------------------------------- --Depth �------- Liquid Capacity-----------------------------gals, t Privy: Distance from.nearest-well_-.-----______________________________ _ Distance?,from nearest building_;=----_--___________________...__ Distance to nearest lot line--------- ----= �-- ------------- .... ---------It _ ---------------------�-------------------------------- ------------------------------------- --- - - Remodeling and/or repairing (describe} - -- ` 4 _ k ------------ ------------------------------------ - ----'------------------------------- . i - - -------------- ----------------•----------------------------------------------------------------------------- ----- -- j' s ft # I hereby certify tha#:I have prepared +his application aind that +he kwork will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of +he San.Joaquin ,Local Health District, a V rf n > sri t= �w -------(Owner and/or Contra or -- By: --------------------------------------- ------ -- --- ------------ - ) L —t ------ -------------(Title)- --------------- ---------- . -- -- ------. (Plot plan, showing size, of_lot,.loca+ton of,system,in relation.#o.wells, buildings.etc., ca�be placed own rhe sinal. FOR DEPARTMENT USE gNLY APPLICATION ACCEPTED BY ,-------`---— ------------- ---- ------------------- DATE ------------- REVIEWEDBY------------------ ---- ------------------------------------------ ----------------•=------------------ DATE------ ----------------------------------------------------- BUILDINGPERMIT ISSUED------------------ -------- ------------- -----------t----------------- DATE-------•--------------------------------------------------- Alterations and/or recommendations:__-___._--._-_-. `_ .. ._._._._ t - ----------------------=--------- I '' i ' -----------------•------------------------,---------•----------------------•------------------ ------------------------------•----'-----------------------------------------------------------------•------------•------=---- ------------•-•----------------------------- --------------------------- ------ I -------------------- ----------------------------------------------- ---------------------------------- L ------------------------------ -------------- ....... - -- ----------•- -- ----- --- ----- FINAL INSP ---=- -- -- --- Date_ i /S SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.GD.