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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ---- ------------------ (Complete in Duplicate) Date Issued ..!! _!._ .. b J --------- — Date Issued .-- .-_ .-. This Permit Expires 1 Year From Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the WOFk herein described. This application is made in compliance with County Ordinance No. 5,49. JOB ADDRESS L CATIO / _ &.4. � Owner's Name---- ---- -.2 ---- -_ -------• ----- - ------------------ ----------------- -------- - Phone------------------------------------ Address................ fJ . ------------------- -�---- ! /f -�- --••---- -----------•-----_----•----.........--------- Contractor's Name--• l--......�- rte!•------------I. - ---- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial Trailers Court ❑ Motel ❑ Other ❑ Number of living units: ___1___ Number of bedrooms sem__ Number baths ___�__ lot size ___.___ -_ .,�S- ..C. ________.- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobe ❑ Hardpan [' Previous Application Made: {1f yes,date---------------- ___1 No ❑ New 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.) , Septi ank: Distance from nearest well©_______Distance from foundation_______ ______Material------ - ________________ No, of com artments.___c;�_ _Size_ 1 L_�' a��Li uid de th___4-1_.__._._ ___Ca acit Disposa field: Distance from nearest well....r ' ..._Distance from foundat' �_. ____.___Distance to nearest lot line__.______ Number of lines------------- ----- --- ------Length of each lin _ of trench._-- -`Z'--------------------- Type of filter material-____ -- ------- of filter material----- __ _«f......Total length______ l �_________________ Seepa fait: Distance to nearest well-------t�D_�__Distance fr m foundation___.1. _.�.___.Distance to nearest lot line.___.: Number of pits___,=9 Linin material__ __.___Size: Diameter-------7__ _'_!_.De th___�. __!______________ G 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---------------------------------------- -------------------------- ------------------------------------------------------------------- - Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------- ----------------- ------------•----------•-----•-------------------------•------------------------------------------------------------------------------------------------------- ------------------------ ------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------ I,hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinAnces, State laws, an les and regulations of the San Joaquin Local Health District. St ned •---•- -- = -- --------------------------------------------------- r and or Contractor By------------------: ---- -. -- _ --------------(Title)-------------------------------- ------- --- - -- --- - -- ----- (Plot plan, showing size of lot, location of system m elation to IIs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY - --------------------------------------------------- DATE l- - `-57------- REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE---------------------------------------------------- PERMITISSUED------------------------------------------------------------------------------------ ----------------- DATE------------------------------------------------------------ Alterations`' nd/or recommendations:.---------- ------------- -------- ------------------------------------------------------------------•-------•--------•--------------------------------------- ------------ ------- --- -••---------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------•--------- ------------------------------------------------------- ------------------------------------------------------------ -------------------------------------------------------------------------------------- JAL INSPECTION BY:...- ---------------- ------------------------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Nozelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California VISEo B-59 3m 3-'63 r.p.00.