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FOR OFFICE USE: 33cr 7 --- `-- APPLICATION FOR SANITATION PERMIT Permit No. ....................... ��—� .' 41_____________ _ _-.________ (Complete in Duplicate) .,v — G ° his Petmit Expires 1 Year From Date Issued Date Issued 1_�. T p 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-CQ�unty Ordinance No. 549. t L-3—160 -33 ................... JOB ADDRESS AND LOCATION--------------- 7 -=-`•=------- � _...__ `' , r --- 'z Owner's Name_.._lY�'�(�� -----••-- :. --------------------- ---------------- Phone.-- ..5 !�--r---��,��'_i!!/f_TZ-a--------• - �� C -------------------------------- Address---------------------------- -1 la----- .4.t z= Contractor's Name------------------ e 1... ---_-------•-----•-----------------•------..----------I__--------------------------------------_--- Phone-.-------------_ -----. ------•-- Ph ne , Installation will serve: Residence w Apartment House ❑ Com ercial ❑ Trailer Court ❑ Motel ❑ Other'[] ' Number of bedrooms --- _--_- nlu Mer o baths ----r-. Lot size -------- -1�- - ---- - •- •----------- Number of living units: 1. . Water Supply: Public system Communify system ❑ private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ij Hardpan ❑ Previous Application Made: (if yes,date----------- _..___J No X New n r.ec : •Y No FHA/VA:A/VA: Yes ❑ No,'�] TYPE OF INSTALLATION 'AND SPECIFICATIONS: N J r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Tank: Disfancefrom nearest well_�Ya ' --_Dis}ante from foundation..___l_t?-_______.Material___ ---- 4- Septic No: of compartments--------- >-------------Size----- -�C= -?t',-- >r Liquid depth__.-------VZ---------Capacity..... __ ® i Disposal Field: Distance from nearest well. ✓¢.Distance from foundation....y_a__�___..Distance to nearest lot line_____.5 ___- , Num' ber of lines----------------L--____--_.------Length of each line-.- _.___._._� -".-.Width of trench----------____-.�/ S,/d Type of:filter.maferial__:_-�_r__k _____Depth of filter material.-__:__!! . ____Total length----------------- - --- p 9 See a e Pit: Distance to nearest'well____1cll / Distance from foundation------jC�__..___.Distance to nearest lot lin _____________-.. -Number of pits------ L ing ma cu ------Size: Diameter------ 3-----------.Dep+h------ ----------------••- '1 Cesspool: E Distance from nearest well-----------------Distance from foundation---.----------------Lining material-----------.---------------_-_______- Size: Diameter--------------------------------- Depth Liquid Capacity---------------------------•gals. s -_____Distance from nearest b0clin Privy: Distance from nearest well--------- ------------------- 5 ❑ --- ---- Distance to nearest lot line---------------- ---------------------------=------------------------ < - Remodeling and/or repairing (describe}: = -----------• i ------------------ I hereby-certify +Fat have prepared this application and that fhe work will be done in accordance with San Joaquin County ` ordinances, Sfate laws; a -rules and regu tions of +he an Joaquin Local Health District. ------------------------( r and/or Contract p (Signed)_ Owne d/o or] By:------_- -•- -------- -• -------- -=---------------- - --------------------------------------------------------------(Title) r (Plot plan, shavring size of lot, I anon of system in relation to wells, buildings, etc., can be placed on reverse side). } FOR DEPARTMENT USE-ONLY APPLICATION ACCEPTED BY-------- ___ . rwt� --------------•----------------- -••-------- DATE----REVIEWED By-----------------------------BY----------------------------- DATE ----------- BUILDING PERMIT ISSUED-------------------------------------------------- DATE----- - --------- - ---)-------------------- Alterations and/or recommendations:__ !-. ---- �1 � - Q °`'� `- -' ' _____----------------- -� ------------•----------------- ---------------- ---------- ---------------------------------------------------•------------------------------------------------------------------ ------------------------------------- -- ------------- ----------------------------------------- FINAL INSPECTION •--- �. � Date----- `fes w. -.7 - / �.� --- `�r� - -SAN JOAQUIN LOCAL HEALTH DISTRICT ! 130 South American Street"' x�` �3oo West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California .� CS-9 RE-SED 8-59 C.P.0 O.1M 6-6G - • _�"--' • 1 3 <