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FOR Of FICE USE: 4,1 - _._--____ --_-----_-___--/� APPLICATION FOR SANITATION PERMIT Permit No. ....._I11.�.. .. ----------- ------------------------- --------------- -- - (Complete in Duplicate) ---..----------------------------------------------------- This Permit Expires 1 Year From Date Issued 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 in compliancewith County Ordinnaajn'ce No. 549. JOB ADDRESS A OCATIO :/ ----------�-- -- �—' -----------•------------------------•- Owner's Nalpe— -.0.19. —•lf-I --------------- .v_ t,1-------------------- ------------------------- Phone.................................... Address '� �. .... ..... .......•--- ---t------ ---�✓ Contractor's Name------------------------� --r " ----------- ---- ------------------------------------------------------ Phone-------- Installation will serve: Residence.[(] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- Number of bedrooms .2- Number of baths/----- Lot size `�_ -__X..�-�.------------------------ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Tablela- f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy am ❑ Clay Loam ❑ C ay F] Adobe ardpan ❑ \ Previous Application Made: (If yes,date--------------------) No - ew 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 T . Distance from nearest well___,-�<_Distance from foundation__v._-----.-.Material_-,C.G- YIC_-��---- -----�` p /1{ U ---Liquid depth------�,��-----Capacity..... _-_-•- No. of compartments Disposal geld: Distance from nearest well.-----'. '.-_Distance from foundation._,J4--!......Distance to nearest lot line.-,,57/.._. Number of lines_____ _ Length of each line_ !1_�_ Width of trench...- . ' / t� Type of filter material.._- 14�4__llDepth of filter material_-/A- -------- length--------��1 _____________________ Seepage mit: Distance to nearest well ----._Distance from foundation___--J4P.......Distance to nearest lot line__>�-------_ I lt' Number of pits..____------------Lining matenaL... Size: Dlameter�_3_"�_--.__.Depth_-s.-.,.s71--------------- 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------------------------------------------------------------------------------ -------------------------------------------------------------- Remodelin and/or repairing (describe)--------------- ) .. . • --•- �• - -.fit. -r T a, .a_. .o... - ...�r ¢ 'q'------------ ---------------------- .4--------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certif t I have re this application and that the work will be done in accordance with San Joaquin County ordinances, State aw , and rules nd r lations of the San Joaquin Local Health District. (Signed) j - . . . -------------------------------------------------------------------------------- ------- -(Owner and/or Contractor) By:.................... • . -- -----_ --- -------------------------------------------------------(Title)-- . - ..... . --- - (Plot plan, showing of lot, location of system i ation to wel , buildings, etc., can be placed on reverse side). OR RT ENT USE NLY APPLICATION ACCEPTED DATE.- ------- -- ---- - ----------------- REVIEWEDBY -------- ----------------------- ----------- -- ------ ----------- DATE------------- -- BUILDINGPERMIT ISSUED------------------------------ -------------------------------------------- --------------------- DATE-------------- -------------------------------------------- Alterations and/or recommend tjons-------------------------- ------- --------- - ------------------------------------------------------------------------------------------------- /a G3. .. . . � '- - - _- . - --•--•---- ��-.---�----- -- .._ :t---_ --------------------•----- ----•- FINAL INSPECTION BY:--------- .. •-- ------------------ Date----------`-�---�._:�`1�------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD.