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F R OFFICE USE: ------- ------------- ------------ ---- - :�` ij ___________+�'--:3�_-� APPLICATION FOR SANITATION PERMIT Permit No. .__ _ �� - ------------------ --- ---------------- -------`------- (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 lication is ma in compliance wifL County Ordinance No. 549. cF i4r�C>�2_a4 ti JOB ADDRESS ANDD�LLOCAT ON__'_ *`--- ,9, Owner's Name--- _ .. ----------------------------------------- -------------- Phone--------------------- 7 A Address------------- --1 -----. ----.p/ei-------- am.. Contractor's Name------------------------ -------------------------------------------- ------------------ Phone' ------------------------- Installation will serve: Residence U90'Apartment House [] Commercial ❑ Trailer Court' ❑ Motel ❑ Other ❑ Number of living units..-/-- Number of bedrooms__ Number of baths _ __ Lot size,. i _�j � -------------------------- Water Supply: Public system ❑ Community system ❑ Private 24/bepth to Water Table .� . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam -❑ Clay E] Adobe Hardpan E] Previous Application Made: (If yes,date--------------------) No New Construction: Yes Q&-No ❑ FHA/VA: Yes ®r No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I ,,��++yy,, / r Septic Tank: Distance from nearest weil---.�s�_-----Distance from foundation_4".7-----------Mater#-- - _ No, of compartments......Z--------------Size---w1.X!X�Le"-Liquid depth_.-- /• ..... Capacity___,f --------- Disposal _-_ *� [� Number of ' ' t __ } p - -- __ --___Distance from foundation----- ---- -------.i�istance to nearest Int liner �-_- _a, Dis oral f isld: Distance from nearest well_J � Length of each line----- of trench-Z-_--___,____ ____-_._.._--___ Type of filter material.,Zj d�/�Depth of filter material___-. _----Total Seepage Pit: Distance to nearest well .__/110401-----Distance from foundation----1*9-------- Dista�e to nearest lot line-4--.1-_,.. '0 Number of pits__a-�r__________Lining material___,-PAP %�i'Size: Diameter__,�'X___ ._-__-Depth, cl _-/ --• A Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material_- ❑ Size: Diameter---- -------------- -----------Depth-------------------------------------------- -------Liquid Capacity----•----------- ---------••gals. . , Privy: Distance from nearest well-------------------------------------------------Distance .from nearest b0clin ------------ ❑ Distance to nearest lot line_---------- ----------------------------------------- l Remodeling and/or repairing (describe)-----------------2&07l._ 4_40,r�� ----------------------------------------- ' ---------------------------------------------------- ---------------------------;.E k--- I.: 'I her certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 , 1� (Signed)-------------------- "e.- -- --- --'-"(Owner and/or Contracta� r y Y- � (Time)__ (Plot plan, showing size of lot, location of system in ion to wells, buildings, etc., can.be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ G -� _— ___--__---___----_-_ c� v ' - DATE----------- ----------------------- --------- REVIEWED BY BUILDING PERMIT ISSUED - - DATE ------------- =-- ^-- - - -_ y.- ----_-_-_----_----------------------------- -t----------:: '--:------- -------- DATE----------------------- c7 G ��Altera+ions and/or aecormendations:_._. -____--- --��- - --_---- - L A ----------- ------ " -- ' ----•-- FINAL INSPECTION BY:_.. j- rSAN _----------- Date 1 ,.,7 C--�-- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lad!,California Manteca,California �.- Tracy,California FS 9 REVISED 6-59 3M 3-'63 F.P-CD. r