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r r, , irrit-c U0t: ---------I------ ---------- G ------------- z;, APPLICATION FOR SANITATION PERMIT Permit No.-'_I 2 z J>``�.: `( '�` U �' �F �'�! (Complete in Duplicate) �� --------- This Permit Expires 1 Year From Date Issued Date Issued Application is,�j y made to the San Joaquin Local Health District for a permit to construct and instal a work herein de cribed-„ This applicat' ade in compliance with County Ordinance No. 549. U-5-rV- 42!�EcA JOB ADDRESS AND LOCATION_ ___'__ 42 rwa - _ Owner's Name-------- t��----------------- �r�-- -- ---h`�;�-.�'.�'_��_•-_--- -- Address -/- f / L •--•--- ---------------- ----------------------------- -- -------------------------- Phone................. ------------- Contractor's Name_ T Installation will serve: Residence r A partment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /- vmber of bedrooms _,L—Number of baths _1/---_ _ Lot size ____1'7 Water Supply: Public system Communit s stem '" Y y ❑ Private ❑ Depth to Water Table 7- t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Ad Har"No Previous Application Made: {If yes,date____.____.--_.__-I No New Construction: Yes No ❑ FHA/VA: Yes - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet,) Septic nk: Distance from nearest well___r"'---Distance from foundation___L2Z._ Mat9rial- - ----------- -- No. of compartments_-____Z�--_-----Size__� _ Liquid depth._,_ /Z_.---------Ca pacify---. Disposal - Disposal field: Distance from nearest well____- .-Distance from fo-undation._�,t 42___----_Distance to nearest lot line_.__�._-- Number of lines----------f----_ - Length of each line_____ �� / g � Width of trench__ ------- Type of filter material__/ r�;% / Yp _�1__.._!'Depth of filter ------- -------- filter length-------__L�__�--------_- eepag it: Distance to nearest well-_-- `° -----Distance f m foundationl- --r----..Distance to nearest lot lineIM" _`_ Number of pits------ -------------Lining material_-- '- - 1 ! p 1 F _----Size: Diameter__..,--------------De tn -----gar Cesspool: Distance from nearest well________________Distance from foundation------------------. Lining material---------------____________- ❑ Size: Diameter--------------------------------------Depth-- ------------ - ------------ ------------ ---Liquid Capacity----------------- --------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line__ L, Remodeling and/or repairing (describe)------- •- -- ------- ----------------••-------------------------------------------------------------------------------------------------------------------------------------.--------------------------------------------- ----------------------- ------------------------------------ - q ---------- ------ ------ ------ - - - ------ --- - -- - I hereby certify that I have pre ed this application and that the work will be' done in accordance with San Joaquin County ordinances, State la s, a d rules a d eons of the San Joaquin Local Health District. (Signed)------------- ---6- By: 6- BY:----------- •------ - y �---- .._. ------------------------------------- - --------- �---- -1- (Owner and/or and-- /or Con}tactor)/ � ------------•------------ -----------------(T- e)-- --(Plot 'I plan, showing size t, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -- '� -------------------------------------------------------- DATE----------�=n_I; '6 3--------------------- LIED - - ------- REViEWED BY- ---------------- -----•------- ------------ - -------------- -•- ---- ---- DATE---•----------------- - -------- - ---•------ -------------------- BUILDING PERMIT ISSUED -Alterations and/or recomtions:------ .__.._. -__------------------------ DA ----------------- ---------- ---------- -G f' -- -- E --------- ------ - - ----- - e' : 44_.� . -- ---- - ---------------------------- ----------- - ��_ �: ----- Lr FINAL INSPECTION BY:.. E' ,C-C4- ------------------------- ------ Date--- SAN ate--SAN JOAQUIN LOCAL HEALTH DISTRICT _ •� 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore StreetJ 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California ES 9 REVISED a-59 3M 3-'63 F.P.CO.