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3` r UF"(-h 115 ! ------ ------------ ----- S -._-_-_-- APPLICATION FOR SANITATION PERMIT Permit No. _ . . ---------------------- ----------- - ------ ----- - : - (Complete in Duplicate) - --------- Date---- This Permit Ex ires 1 Year From Date Issued Issued ___"� 1_ - �5� Applicafion 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 Ordinance No. 549. JOB ADDRESS AND LOC ON-__.._______ -- --�------------ -----------6241---ew ----------- ---------------------- Owner's Name �ae, -- -,5 Phone Address----------------------- ----------ZI----•---J-9: Is--------4P---4-141e--------------- Contractor's �-- � a ` Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court 0 Motel ❑ Other ❑ Number of living units: __/_ Number of bedrooms ---Z-Number of baths -._ Lot size ._ _- ?d_ '�. /_.9 L _ --------------•------- Water Supply: Public system Community system ❑ Private [] Depth to Water Table -ESO ft. Character of soil to a depth of 3 feel: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ i Previous Application Made- (If yes,date___________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 9 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------ .__.____.._.___-_________.__.._.__ ❑ No. of compartments-------------------------Size------•-------------------------Liquid depth-------------- ----------Capacity----------------------- Disposal Field: Distance from nearest well-----------------.Distance from foundation-- _----___-_.--___Distance to nearest lot line-_---------.-_- El YPer of I---------------------------- --Length of each line-------------------------.-...Width of trench -------- T u ebof fi!er ma erial_________________________Depth of filter material--_----_-___.______-..Total length-------._.---_____-_ ---------------------- Seepage i : Distance to nearest well---------------------Distance40, o n tion---_ 6 -�-___ istan+e to nearest lot line-__A�__�-- Number of pits..._--�._-._------Lining material- Size: Dia meter-__� J.---___--Dept h.._._.---------------- Cesspool: Cesspool: Distance from nearest well.-. from foundation....................Lining material---------------------------_--------- -- ❑ Size: Diameter__.-_I__ _____ __ ______ Depth------- - Liquid Capacity ------------gals, Privy: Distance from nearest well_________________ _______________________._-- Distance from nearest building g --•---- ❑ Distance to nearest lot line-- ---------------------- ----------- ---------------------------- - ------------- - Remodeling and/or repairing (describe)_____________ _ r- i ---- ------------------------------------------ ------------------------- - 9 e ------------------------------------------------------------------------------------- 1 hereby certify that I have r Fred this application and that the work will be done in accordance with San Joaquin County' . ordinances, State laws, and r an re ulations oft San J u Local Health District. t (Signed}-------------------------- --- -- - -- ---- -- ------ ------------------------------------------------- ------ -{ a /or Contractor) By:----------------------------- --- __1- ----- ---- -- (Pl --- -------(Title)----- at plan, showing size of I ation of system in elation to wells, buildings, etc., can be laced on reverse.side] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY W -- -----°--------- - - -------------------------------------------------------------- DATE �� ---- --- ----- ------ --------------- -"A BY------- -- -------------- --- ----------- -�---- -- --------------------------------- DATE---- --- -----------•---------- -- -"A-------------------------- BUILDING PERMIT 155UED-----------------rl � -------------- . DATE.--- -------------------------- - . ----------------------------------------------------------------- ---------------------------- Alterations and/or recommendations_________________________ = '------------------------- -------------------------------------------------------- --- = '• --------------------- ----------------•---------------------------- ----- ----------------- ` ----- ': _z_�� ----t ------- ---------------- - ------------- ------ ------------- FINAL INSPECTION BY:-.----- =--- ------------------- -- ---------- Date--------2.. 7 -,64—---------- ------------- ! SAN JOAQUIN LOCAL HEALTH DISTRICT 1 1601 E.Hazelton Ave. 300 West Oak Sheet 124 Sycamore Street A - 205 West 9th Street Stockton,California Lodi,California Tracy,California Manteca,California