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A;,FOR OFFICE USE:" . t _ APPLICATION FOR SANITATION PERMIT Permit No. ..lwQ."" -------------- ---- ------- --------. (Complete in Duplicate) - --- --- -------- ----------------" This Permit Expires 1 Year From Date Issued Date �Ssued "-l______{�A-1:75 Application is 1Zereby made to'the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in`compliancewit County Ordinance No. 549. _ JOB ADDRESS AND CATION Owner's Nam --•--•-----•------------------------------------------------------------------Phone-------'-----------•----•----------- Address.•. . +, ; Contractor's Name ✓ ---- ---------"- Phone----------------------------------- Installation will serve: i Residence �A artment House Commercial ❑ Trailer Court ❑ Motel ❑ Of}er ❑ Number"o Number of�livin units: _ Number of bedrooms f baths _ ._ Lot size !, g �--- .. - - -- --- ---- �---- ------------------------- Water Supply: Public!system 4-_�Community system [b a Private ❑ Depth to Water Table_#A t Character of soil to a depth of 3 feet: Sand ❑ Gravel E]'I Sandy loam ❑ - Clay Loam ❑• Clay ❑ Adobe jHardpan ❑ Previous Application Made: (If yes,date--------------- __._) No New Construction: Yes ❑ No PRO'FHA/VA: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: \' 4` 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se,ajic Tmnkk: A Distance from nearest well------._'-------_Distance from foundation_____ __j_-----�Material------------------------------------------------- NoJof compartments_--------------`--------Size---------------------------- Liquid de0R -Capacity---------------------- Dl�osaL.Fiel Distance from nearest well___.____§__.__._Distance from foundation--------------------Distance to nearest lot line._______.________ Number oflines- -------------------------- ------Length of each'rlirie-':=--= -- --- Width of frenc h 6 / Type of filter material_________________________Depth of.filternateria--------------------------Total length------------------------------------------ 4 d SeeVNumber it: Distance to nearest welL____°^"�-_.___Distance fro jfoundation----�.�.......Dis�j Distance to nearest lot of pits------/------.-----Lining material---f --Size: Diameter_. ,,7______--------DepthU__�'/Ad Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-------------------------------------- �❑ Size: Diameter------------------------------ -------Depth---------------- -- --- -----------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well:_..___ ________________________________ Distance from nearest build!rig___._____.______________________--.___._- ❑ Distance to nearest lot line----------------- --------------------------------------------------------------------- ------------------ ------------------------------ 0 s5 Remodeling and/or repairing (describe):------------------LR ------:AZele44- �' I €----------------------------------------- --------------------------------------------------------- --•---------- ------------------------------------------------------------- 11 = - F -----------------------:------------ ------------------------------------------- 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, nd rules and regulations of the San Joaquin Local Health District. (Signed)------ - - L► �/ ---------- ------------ (�or Contractor) By:...... :.... = = (Title)- ---------------------------- (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). A FOR DEPARTMENT.USE ONLY F APPLICATION ACCEPTED BY------------------ ----- ----e ----------------------- - DATE----_ I'� — � " -------------------------------- ----- 2 --------------------- ----------------- ------ REVIEWEDBY--------------------------------------------- ---------------------------------- --------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED - ------ --_------------ DATE Alterations and/or recda dation -------------- -- ------ ---- - --®--- ------------------------------------------ T •--------------------•--•---•----------------•---------- 6 � -- -- --------------------------------------- ------------------------------ (1v? ---- ----•------- --------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------I------------------ -------------------- FINAL INSPECTION BY:......4...... --------------------------------------- `':Date---- lz = - -------------------- ---------------------------- ((NAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. X300 West Oak Street ��; T 4 Syca ofrq 205 West 9th Street Stockton,California 44�-L'odi,California Manteca,California+ Tracy,California E5 9 REVISED B-59 3M 3-'63 F.F.CD. � -