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OR OFFICE USE: . r y_ __-_� _G -- ------------------ -'_y -- APPLICATION FOR SANITATION PERMIT Permit No. �p. ! -_,T (Complete in Duplicate) M �" - Date Issued -----------------------------------------------------..__ This Permit Expires 1"Year From 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 application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION..._ ,74k. _Z60_ , til, Owner's Name-- .........�V ----=-•-•------• ------------------=----- ------------------------------ ------- Phone-.-.-•.......-------- Address---- � ........-` r Name--- ---- ------------- Contractor's 7 ---T5---------------------------------------------------------------------------------------- ...... Phone----------------------------------- Installation will serve: Residence V5 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. Number of bedroom's _ Number of baths _1____ Lot size -4/9Y10_0___________________________----------- Water Supply: : Public system � 4mmunify system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E❑ Sandy Loam,❑ Clay Loam ❑ Clay ❑ Adobe-B--Hardpan ❑ Previous Application Made: (If yes,date--------------------I 'No New Construction: Yes ,21--ITo ❑ FHA/VA: Yes ❑• No-Eq� TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.)- Sept' Tank: Distance from nearest well--------t--------Distance-from foundation_-_-__-_________.Material---------_--------------------------------------- x�.. k No. of com artments------- -- -----------------=-Size-•--_---------------- p `--- -_---Liquid depth---------------- ---- ----Capacity-----------•-----•--- Dispo Field J Distance from nearest well ................Distance from foundation---------------------Distance to nearest lot line----------------- — Number of lines-----------------------------------Length of each line-------------------------:----Width of french------------------------------------ Type of filter material---------_----------------Depth ofvfiite material____________ _____Total length_______________________.____;__ --___._ Seepage It: Distance to nearest well_"_ ________-'-Dista __rria: m oun tion_�9--------.___.Distance to nearest lot line_S__-._.._ [ar Number of pits--___-1---- ---:--Lining-m .. .! ..___- 3- --- p --• ,. - ize: Diameter_--� --__..De th------��----------- -- Cesspool: Distance from nearest well----------------- from f ndation-------- _.-__.__.Lining material----.-------------------------------- El Size: Diameter - - r Dcspth- =` Liquid Capacity - - gals. n Privy: Distance from nearest well_-------_________�------.z__-...-___...____._Distance.from.nearesf.building-------------------------...-.`._-______._. ❑ Distance to nearest lot line----------------- e-------------- ------------------------------------------------------------------ ----•----- ------------------=-------- J Remodeling and/or repairing (describe)=--------- --------------- ---------------------- =----------------.....------...- -------•------------------=-----------------------•------------ A -•-•-•------------------••-•---•------•--------------------•--•--------------------------------------------------------------------------=--------------------------------------------- ------------------------------------- 1 ---•----------------•-------------•-•-•-------------------------•-----......------•-------=-•--•-----------------------•-•--- ----------------------------- { ----------------------------- ------------------------------ --------------•---------------•-----------------------------------------------•------------------------------•--•------------------------------------------- I hereby certify that I have prepared this applicaf' nand tat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of t e an J aquin Lo I Health District. ------------------------------------------------------(Owner and/or Contractor) (Signed)-------------------------- -------------- -- --- -- - - ------------- ----- ------------------------------(Title)---= --------------------------- --------------------- (Plot plan, showing size of lot, location of system to elation to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �e , APPLICATION ACCEPTED BY--------- =--------------f--------------------------------------- DATE--------11''� �,��, .----- - -- --- ---------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE---------------------------- BUILDINGPERMIT ISSUED------------------------------------------- ----------------i------------------------------ DATE--------------------------------------------- ------------- Alterations and/or recommendatio -----------------------------_______________ -- --- - ------------------------ --------- �-- --------- - ' .-"--------------- � ----------------- ---------------------------------- ------------------------------------------------------------------ --------------------------------------------------- ---------------------------- --------------------------------- E -------------------------___________------------------------------------------------------------_--------------_-------------------------------_----------------------------------------------------------------------------- --- Date---- ?_r: --------------------------------- FINAL INSPECTION BY:__--_---- --'-----,�Gl�--------------•------------- �--'- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avs. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 9-$9 3M 3-'63 F.P.CO.