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FOR OFFICE USE. ____._✓__...___._. ,r{./�Z-__�Q_ APPLICATION FOR SANITATION PERMIT Permit No. ...��l.5___d --------------------------------------------------- (Complete in Duplicate) Date issued /j/ f ---------------------- This Permit Expires I Year From Date Issued .._____..1�...�`x- 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 Ordinance No. 549. JOB ADDRESS AND LOCATION /...-59 '�f.........57/--'?r--Sr ------------------------------------------------------------------------------------------ r � Owner's Name---•---.��i..._. Phone ..... ------------------------------------------------------------------------------------------ Address......_.� v ems' ----------------- = Contractor's Name-----•------- .......... ' _---- _-------- Phone.................................. Installation will serve: Residence 'Apartment House E] Commercial C] Trailer Court_QMotel El Other [INumber of living units: _,/__ Number of bedrooms n. --- Number of baths -___ Lot size .'r'�'-______-__ Water Supply: Public system [�Communi+y system E] Private E] Depth To Water•Table _f40ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe OROdardpan ❑ Previous Application Made: lif yes,dote--------------------) 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 300 feet.) Septic Tan 1 Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- No. of compartments---- ----------------Size--------------------------------Liquid depth--------- -------------•-Capacity-•-•-----------•---•--- t y7 Disposal Fief}: Distance from neare�welL.-,.�.r ,-Distance from foundatio�l._ �.._._.Distance to nearest lot line_________________ � �j Number of lines------- ____ f_ Length of each line____•_______ _ Width of trench.__, ..._._______._________...__ Type of filter material. ,�fGQ .___Depth of filter material____ __� Total length____- ,________________________ eepage Pit: Distance to nearest well____ T-------Distance f m,,ff�o}�L ation___• -10, s nce to nearest lot line____----- Wj Number of pits___._______-___Lining material__ _/Size: Diameter .__._-..Depth__.2049- .._____ 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------------------------------------------ ElDistance to nearest lot line------- .....................................................•--------------------------------------- Remodeling and/or repairing (describe):---------------- -------------_---_ ---------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, d es and regulations of the San Joaquin Local Health District. (Signed)------------------- -1-C- - --------7."Cla-4-- -- ---- -------- ---- Signed) ------ - ---------------(fir Contractor) By:--------•-------•------------------ ---------------- ---------- [Ti+le) ----------------------- (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY L r - ------------------------------- --------------•----------••---- DATE---Iz- REVIEWEDBY_-------------------------------------------------------------•-------------------------t-----•---•----_ ................ DATE-------- --•-------•------•-------------------------------- BUILDINGPERMIT ISSUED---------- ------------------------------------------------------- ..__..-I--------------------. DATE--------------------------------------- :------------ A#Ferations and/or recommend tions:_fZ.._-rtD_-__fo:�____..__{�`_.j__fes_ _ _ � — •- .•---------------------------------------- -------------•------------•-•---•-••-•------- ----•-•------------------------------ ---------------•---•---------------•----------•---------------------------------------------------------------•j---------•---------------------------------------------------------------------------------------------------- --•------------------------------------ FINAL INSPECTION f3Y:_._.._C .. Date----!Z-'--)---- - --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Stmt 300 West Oak Strout 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES % REVISED 8-59 2M 5-62 ATLA5