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FfJR FF10E USE: S r ' ," •� r, .� Z A L+ a 4 9 M APPLICATION FOR SANITATION PERMIT Permit=lVo- --- ----------- ----- -------------------------.-----------------------_-------- (Complete in Duplicate) � y __.._-_ This Permit Expires I Year From Date Issued Date Issued ______._______ - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here-:n described. This application is made in compliance with County Ordin nce No. 54 Ik 4 I r JOB ADDRESS AND L CAT N � _4� - ------ ------- ---------------------••----------------- R r -- Owner's Name - r - ---- Phone.-..-------------------------------- -------------------- _____________________________Address------Q3J1---yy- q lf C. Contractor's Name----------------- -------------------------------•---------- --- Phone-------------------------•-------- Installation will serve: Residence V Apartment House ❑ Commercial ❑ Trailer Court [I Motel ❑ �Otther ❑ Number.of..living units: p Number,of bedrooms#_ Number of baths : Lot size __, Q--f Z�W o------------------------ Water Supply: Public system Community system E3i Private ❑ Depth to Water Table 6-C- ft, ) Character of soil to a-depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] ` Clay Loam El Clay ❑ Adobe ` Hardpan E]Previous Application Made: (If yesrdate---------------___.1 No E] New Construction: Yes E] No FHA/VA: Yes E] �No ❑ TYPE OF IFNSTALLATION. AND SPECIFICATIONS: t ` (No'septic tank or cesspool permitted if public sewer is available within 200 feet.) t k: Distance from nearest well________..____�Distance from foundation__________________Material______-__________.______--.___.____--________- No_ of com artments----- -------------- Size------------------ ----- Li uid de th------ p q P. ----Capacity-----------�----------r 1 � y-,, + r i Distance from nearest we11� 6 '._.lDistance from foundation_ 0_________-Distance to nearest-lot lin e�a�_- 4....... ,,.n 7— it m.` Number of lines-------- --------- - Length of each line-___�C�--___��-_r_--"Width 8�f_trench__-- ---�_______.�-----_--•-- B a =, i al_,a.. -o.Type,of,filter.material_ Depth of filter mater al__!-g__ __I_____Total length_________________: Distance to nearest well_ ---Distance m f nclation_ C _____.__ Distance to nearest lot line_�1 Number of pits________ _ __________Lining material__ _ __ .-Size: Diameter. .-___..- -___Depth__-_! _ ------- ---------- V,► Cesspool: Distance from nearest well-----'----------Distance from foundation-------------!___-..Liningrnaterial-----------------------.___________ ❑ . r•-Size: Diameter----------- - ------Depth-- ---------!t'r--------------------------------Liquid Capacity--------------------t- gals, ' Privy: ':'� Distance from nearest well____.______ . _________ -_`_-_Distance.from nearest building_____ ----------------------------------------- __--- ------------------ . ❑ '=Dis}tante to nearest lot line- .---------------------- i-- ----------i--------f---,-------------------------------- = 1 Remodeling land/or repairing (describe)-------------_----------------------- -----------------•-----:--------•---------------------- -----------------------------------------= t= --------------------------------------------------------------------------------------------- -------- -- --------------------------------------- ----- - r I hereby cer 'fy-that thave°prepared this-applicatidn and that the work will be done in accordance with San Joaquin County ordinances St a aws, and rules and regulations of the San Joaquin Local Health'District. (Signed) ` = =-- _- . V, -__,10wner and/or Contractor) ------ - _ {Title) -- -------------------------------- By:.!,(Plot plan,.`showing size of lot, location of system in relation to ells, buildings, etc.,ican be placed on reverse side). _ FOR DEPARTMENT USE ONLY) I APPLICATION ACCEPTED BY--------- --------------- ---;---- DATE-------- �_-r ----- -- " C --------------------- REVIEWEDBY--------------------------------------------------- ---------- -------)-----------------------------------------{--`- 1---- DATE----- ---------------------------_-------------- BUILDINGPERMIT ISSUED-------------------------------------- --------- ----------------------------------------`------- DATE--{-----------=------------------------------- -------- Alterations and/or recom a dat-ons:._.______________ ____________ ____.-_ '� a t -----------------:---------- ------ ------ ---- ------------ --------- -------------------------- ------------------------------ ' ' = ............9-7 n-- ----- ` : t _____________________--_1____- -______"_.______5___--___________3._________.__-________--_.,___.--------- ---------- a' ._._.__.._____-________________________ _ ___._--_____-_-.___ ____-_-____---___-._.-._._______-._____ ..----__-__ __ FINAL INSPECTION BY:----------- Date_....-- y'+!,Q SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California lad!,California Manteca,California Tracy,California ES 9 REvISEP 8.59 3M 3•'63 F.P.GO.