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OR OFFICE USE: -------------- -- d - ------------ ----- --- ------ ---------- APPLICATION FOR SANITATION PERMIT Permit No, . 1J........ 3-- {Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued __41710-Y 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 compliance with County Ordin rice No. 5 9. JOB ADDRESS AWDCATI N--- -- -- -- 1 ------"-----� .-------------------------------- t,� Owner's Name -------- Phone--TA--�- J - � LL Address`•gyp d� -- lj----i { ----- ----------ry - Contractor's Name :1 -�_ _ ---&-�- '----9-1.1. - ------------------------------------------------------------ Phone.-41---&J-b_�!-- Installation will serve: Residence [1 Apartment House E] Commercial E] Trailer Court [jlMotel El Other [_1 � Number of living units: --- --- N ber of bedrooms ---_C- Number of baths . ____ Lot size ----ID-.� ).------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 6J ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ dobe Hardpan ❑ Previous Application Made: (if yes,date --------------- ___) No 17-1New Construction: Yes E] No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se T Distance from nearest well----------------- from foundation--------------------Material ---_-__---_-_-__-_-_-_-_--.-----._-_--._-.__--. No. of compartments-------------------• --Size------ ---------------------.--.Liquid depth---------- --- -----------Capacity----------------------- Sosal ie d: Distance from nearest well..4a7LA.-Distance from foundation..-10..........Distance to nearest lot line--_---c�-----_. Number of lines------ ---------- of each line--_-_ ----------- Width of trench Length Q �_ Type of filter material_. __ _--Depth of filter material--------- ______Total length----------------------- .l Seeps a Pit: Distance to nearest well_-*M� ----__Distance from foundation-NS-�---.Di ance. o nearest lot line------��- t' Number of pits---- ..______._r____Lining material-_R�-<�_-_:_..Size: Diameter._____ __ _ --Depth---. .__.---._._ r� Cesspool: Distance from nearest well____.____--.---Distance from foundation--------------------Lining material_-.---------------------------------- El .___._.-- _-----_❑ 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)------- - ----- - ------------ -------------------------- --------•----•-------------------------•------------------------- --- --- ------ --------------------------------------------------------------------------- --�c-t � ----------------•----••---- --------------------------- ----------------•-------------------------------------------------------•---------------•-----•----------------------------------------------------------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. (Signed)------ `"'- 1.�'d`a'{ y` � ( d�oj Contractor) - ------------------- By:--------------------------------------------------------------------------- -------- -------(Title)---------- -------------------- ------------ - -- ----------- (Plot plan, showing size of lot, location of system in relation to 4ells, buildings, etc!, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- --- f-,.rte-F'` ------------------------------------------------- DATE-------- ' ��= ------------------------ REVIEWEDBY---------------------------------------------"------------- ---- DATE--------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:----._-.---- ------------------------ - -- �'` >r'= ------- --------- = =---------------------------------------------------------------------- --------------------------•--------------- --------------------------------------•-------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------- ------- I----------------------------------------- -------------------------------------------------------------------------------- ---- --- ---------- ------------------------------------------------------------------------------------------------------------- -•--------------- FINAL INSPECTION BY:.. C_.:.�I" .�----------- -------------------- Date---- ---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 7 nEVISED B-59 3M 3-'63 K.p.ra.