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FOR OFFICE USE: ------------------ b APPLICATION FOR SANITATION PERMIT Permit No. .........:......... ----------------------- (Complete in Duplicate) _f (d ----------------- -- - Date Issued --------1-- r------- 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 Ord• ce NP. 549. `/`` .. �----------------------- w"'�f e- -- --- ----------------------------- ---------- ----------------•---------- I JOB ADDRESS AND LOCA N_____________ ____ Owner's Name r Pone � . ------ -- Address f � -�`� 6 -------R-_u-��-1� Q111/ J. ET t u�------.------------ Contractor s Name •-----~�� '� /� ----- Phone--------- ----------•--------- Installation will serve: Residence Apartment House El Commercial ❑ Trailer Court E] Motel ❑ /Other ❑ jr Number of living units: ---Z Number of bedrooms _ __ Number of baths _ --- Lot size � -�----0 - -------------- "------•-- Water Supply: Public,.system [Community system ❑ Private ❑ Depth to Water Tabler�� ft. i k `� -.t r.. t4 t -� f •f = r .'of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Character.of soil to-a depth yes, —,New Construction: Yes ❑ No`❑� PHA%VA: Yes ❑ No ❑ Previous�Apphca�ion Made.:�.(If yes,date_..---_._..:_.___- } No ❑ , TYPE O.F INSTALLATION AND SPECIFICATIONS: �.� .(No'septic tank or cesspool-permitted if public sewer is available within-200 #ee{,) 5 tiaz T6 n0, Distance from nearest well---------------- Distance from foundation-------------- ----Material-------------------------------------------------- No. of compartments--------------------------Size----------•--------------------Liquid depth--------------------- ----Capacity-------------- -------- Disposal f i Id: Distance from neares w IL-.-W^"✓'__.._Distance from found ti _.'__--Distance to nearest mot line--_ ------_ _ Len th of each line Width of trench- .--.----,-- `�� Number of lines------------ -- - - g --'� ---- �----- � Total len, th + r Type of filter material- -- --- Depth of filter material- __----_-_ ;i Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------__.-___-... ❑ Number of pits-------------------- Lining materia'---------- ------------Size: Diameter---------- --------_ Depth------------------------------- j Cesspool: Distance from nearest well-----------------Distance from foundation--------- _Lining material------------------------------------ ❑ Size: Diameter---- -- -- Depth; _ ,.L-i uid Capacity_._.,--- --.gals. . .. x �� — °building.. d.r•� 'r - =, f., -- ----------•----- ---- Privy: Distance from nearest well------ --------------------------_-._ _:-- Distance from nearest ing.- ,r ❑ Distance to nearest lot line--------------------------- ` f .r i.. Remo el'ng nd or re airing (describe):---------------� --_ --- ---- ----------- PULL ----- ------------------ ---- e---------------------------------------------------------------------- ----------------- -------------------------•-----•---------------='--- ---------------------------------"--------------------------- I hereby certify that I have prepared this application and..Jhat the work will be done in accordance with San Joaquin County +t-,. E. ordinances, State laws, and rules and regulations of the-San Joaquin Local Health District. 1.-'k ,l (Signed) f _._._=( or Contractor) - -- 3- -----------(Title)-- ------- --------- - ------- i -_ BY:------------------- (Plot plan, showing size of lot, location of system in r ion to`wAls, buildings, etc., can be placed on reverse side). k FOR DEPARTMENT USE ONLY ` ..8 -y R —I- F k'� f-4 ' I ; F ---------•------------------------------------ �'------ -----------------------'-'"DATE --------------------------- APPLiCATION ACCEPTED BY_.�^t.��-�-------- ------•-=•----- -----=- - -� -- --� REVIEWED BY--""_`_W. ;��4 +�-s. _- =` `+� ..� ' � ./ DATE ' _. F BUILDING PERIv11T�IS5UED- .� 4�- -------------------- DATE a _ --------------------------------------------------------------------------------- Alterations and/or recomm4.7 .1 1endefions----- --- - ---- • •--------- ---------•-------------------- -------------------------------- ------ ---------------------------- - c_: y _ _ ---.. ---- - .-...-- -- - ------------------------------------ ___-_----__-__--_- _.--.----"--.-_---,---.-.__'--------------..-------------------._----------_- } - - --------------------------- ----------------------------- FINAL INSPECT10 B .- Date.... 1 -- 1 ----------- SAN JOAQUIN LOCAI:'HEALTH DISTRICT 1b01 E.Haselton Avs. Soo West Oak Street ,, 124 Sycamore Street 205 West 9th Street y Stockton,California:,:; Lodi,California 'Manteca,Caiifornia Tracy,California ' L i. •YY;. t , E5 9 REVISEa 8-59 3M 3-`63 F.P.C4.