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FOR OFF17 U t I�_ 12- 7 ... . .. APPLICATION FOR SANITATION PERMIT Permit No. _4� -------------------------------- ------ ------------- This Per (Complete in Duplicatel Date.Issued ---/// ----------------Z------------------------------------------ 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 ION. /,XPC -------------------------------------------------------------------------------------------- Owner's Name------------- ----r- V. A- _/�---------- LOCAT ------ ------------------------------------------------------------------------------------ Phone-------------------- Address-----------------------=- i. A Confractor's Name----- -- ----------- - ------------------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serye: Resiid�ence Apartment House E] -Commercial C] Trailer Court E] Motel E] Other El,.i,, f Number of living units; --)----.Number of bedrooms.... Number of s --/---- Lot size ------------------------------ .Water' Supply: Public system j? Community system'D Private Number to Water Tabl9(1.S___ ft. Character of soil to a depth of 3 feet: 4 Sand E] Gravel E] Sandy Loam El Clay Loam C3 Clay E] Adobe [R- Rardpan Previous Application Made. (If yes,date_..---._.._..__._.-) No HNew Construction: Yes 0 No FHA/VA.. Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:. (No septic tank or cesspool permitted if public sewer is available within.'200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundaf'ion-------------------Maferlai--- --------------------------------------------- No. of compartments--------------- ---Size-------------- ---:-- Liquid depth----;--------------------Capacity------ --------------- Disposal Feldl Distance from nearest well__..............Distance from foundat�ion--------------------bistance to nearest lot line.._..._-.---.._. S j/•✓L' Number ine----------------- Number of lines-----------------------------------Length of each line----------- --------------Width of trench----------------------------------- Type of filter material--------------- ---------Depth of filter material------------___.Tofal length----------------------------------------- Seepage Pit: Distance to nearest well------------- --------Distance from foundation-- i .-.D* tance to nearest lot line-15-- ------ - 'Number of pifs-- ------ -----Lining material -Size: Diameter_. !6� De ------ 1:: Cesspool: Distance from nearest well----------------Distance from foundation........._...-'---_Lining material-_-.----_.__-___ ------- k --- W. Size: Diameter---------------------------------------Depth----------------------------------------------------Liquid Capacity-------------------------•--gals Privy: Distance4r;om nearest well. nearest building-=---------------------------------------- _' ❑ u0clihg------------------------------------------- F1 DisfanceIto nearest lot line-- ------------------------- ;---- ----I T I , i. 11 J _A 'be):-------------- ---------------------- Remodeling and/or repairinv(clesirj -------------------------------------------------- - - ----- I--------- ---- ------------------- ----- ------------ --------- -------------------------- ------------------------I--------- ---------------------------------------- -----------),--------------------------i--- ------------- ---------------------------------- ------------------------------------ ----------------------------------------------- ---------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared +his4pplicafio'n and that the work will-be done in accordance with San Joaquin County ordinances, Sta e ws,y&jules and regulAions of +he San Joaquin-Local,Health,District. . su v (Signed)------ -- ----------------------------I------------- - --------- ------------------------------ --------:ti".�7, _._(Owner and/or Contractor) s� y, 1. & I By:------------ - -- - -----------I---------------------------11----------- ---------------------__(rifle)----—------------------------ ----- --- - ------ ---- 'c' d on reverse side). (Plot plan, shoVi size o lot, locati n system in relafionJo wells,-.buildings. etc., can be pli e ir IP R_DEPARTMENTi _U$_R ONLY APPLICATION ACCEPTED BY--------- ------------------- Ir j ---------------------------- ---- ----------A------------------�DATE-------- REVIEWED BY--------- ----------------------------- ------------ ------ -- ------ DATE------------------------------- BUILDING PERMIT ISSUED-----------------------------------------------------------=•----------------------------------------- DATE-------------------------------- ------------------------ '� Alterations ATE------------------------------------------------------------- Alterations and/or recommendations.------ -3 --1---C----------------------------------------------- -------------------------------------- --------------- ----------------------------------- -------------------- ... -------- ---------------------------------------- -------------------------- ------------------------------ -------------------------------------------------------------- ----- -- .... --------- - 00 ------------------------------------------------- ------------ ------- --------- ----------------------------------------------- --------- ----- ------ __1--.4 -----6-K .......................... -------------------------------------------------- ------------------- --------------------------------------------------------------------- ----------- - ------ -77 FINAL INSPECTION- BY_---------------------- -- Date ------- ------ Q - - -- ------------- _ SAN,JOA UIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. A pest%Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California 0,_'Zv';Manteca,California Tracy,California i ES 9 REVISED 5-59 31A 3-'63 F.P.CO.