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FOR OFFICE USE: ., x y - ,,� � . ,,; JYf/ GI7�.. ----------------------- ---------------- ----- ---- Tf= -s APPLICATION FOR'SANITATION PERMIT ' Permit No. ._..---_-•------- ----------------- ------ ---- -- z- _--- -- k (Complete in Duplicate) Date Issued .-s/4.511 ------ 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 Ordinan e Vo. 549. ------------------------------------------------------------------------------------ JOB ADDRESS AN L CATION-----�---- -- .. ��,, �� , ..��f.' . Phone-; " ------------- --------------------------------- TOwners Name------ - -- - - •-- --•-••---•• - - � - .. _ Ad d ress---------------- t ---------•---------------------------•--•-------- - ----- -- ----- --- ---- --- ---------•--------' ------•---------- .------ Phone_--_--------------------------- Installation Name_____________________ _ _ - - i Installation will serve: Residence Apartment House ❑ Commercial ❑` Trailer Court ❑ Motel ❑ Other ❑ f 10/ Number of living units: __/__ Number of bedrooms __`',Number of baths (-- Lot size -4-_- --- --- -- i // Water Supply: Public system ❑ Community system ❑ Pri vats Depth to Water Table4' ft. f Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 5;n ykLoam ❑� Clay Loam ❑ *Clay ❑ Previous Application Made: (if yes,date-------------- ----} No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ i` TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feat.) OpIn Distance from nearest well_________________Distance from foundation--------------------Material-._____-_____________.____.______-....__._____- Size------------------------ ------Liquid depth-------------------------Capacity----------------------- No. of compartments-------------------------- - : Distance from nearest well________________Distance from foundation Distance to nearest lot line_______.._._____ Number of lines-----------------------------------Length of each line---------------------------- -Width o trent ------------------•-------------------- Type of filter material_-.____.___. ----_--Depth of filter material-----------------------Total length----------------------.-____.__._____�___ QQ Distan m f ndation-__3_� Dhtance to nearest lot line.--_"S__---__ Seepa Distance to nearest well_,.CJ.----____ Linin material ---Size: Diameter/� ----- Depth--- _f _f_-- ---•- �' Number of pits 1 9 1 �` f �*� II __ Cesspool: Distance from nearest..well-----------------Distance from foundation._._-_______----Lining material-__.__._..__.__--------------- ala. ❑ -------._.Liquid Capacity--------------•----------- Size:. Diameter. -----�-----------"------ --------Depth-----_--'--�------ --------- -------- g --I_-._ -- --Distance from nearest building------------------------------------------ L Privy: Distance from nearest well-------°--.._____.__ - t � ❑ ------------------------------- 40 Distance to nearest of ins------------------=----- � i i # T *---------------•--------------------------------------- Remodeling and/or repairing (describe)__________________.___________--._.. ------ { 0 --- - -------------------------------------------------- ---- - =----------------- ;y r -- -- ---- ---- -- ----- -- _ I heT tify that I have prepared,this..application and that the work will be done in accordance with San Joaquin County ordinanclaws, a rules and regulations of the San Joaquin Loca! Health Di�rict. '. , _ Owner and/or Contractor) (Signed} -- ----------------------- -- -------------------- Ir , :,__ _----------- ----------------------- By (Title} F (Plot pian,showing size of lot, location of system in relati to wells,..buildin s, etc., can,be placed on reverse side). V FOR DEPARTMENT USE ONLY /�' DATE--------------� f------ ((---------------- APPLICATION ACCEPTED BY---------------rv----------- -- --- ---- �------ REVIEWED BY----- --------- -------------- -------------------------- ------- - --------- ------ ----- ---------- ----------- ------------------------- DATE--------------------------------------------------------- 1---- DATE------------ ------------------------- BUILDING PERMIT ISSUED-------------------- --------------^------- ------ r�t r• — �-� -� c/I� _�1 - Alterations and/or re�c/omm�endations.---- -------�-- - ------ ----- ------ ------------- ----------------------------------------------- -------------- -------------------- ----- .� � �..[ ". c. � -'�-�'-'��.�'4�---`-=-`4{`'�'"�'=-�- --:--��•f�-------------- -•�--�------- -------------' - rl -1 ---- -- t _ / Date------ ---/.. -.,1`.. � ------------------------ ti FINAL INSPECTION BY:.._- .• / / AN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Naselton Ave. 3- ow West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISER 8-59 3M 3-'63 F.P.CG.