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FOR OFFICE-USE: i �---- -- � - APPLICATION FOR"SANITATION PERMIT Permit No. V -- _----- ___-._ , (Complete in Duplicate) -------------------- �----------- - Date Issued ......... -----------------------_..._ 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 Ordinance No. 549. JOB ADDRESS AND LOCATION:-. / ------ - ---•---=-'----- '.� � G� Phone s-- az OwnersName---------------- -----°J----------------------------------------------------- Address----- ------------_-------------------Address----- - - _... - .t --------------------------------------------------------•--------- - ------------- r .. - Phone ..f7...!- (� Contractor's-Name_,:t' t'• =_---" - —1. -yy Installation will serve: 'Residence [B�Apartment House ❑ -Commercial E] Trailer Court [IMotel [I Other El t * Number of living units: _"/"" Number of bedrooms__ _ Number of laths _/__ Lot size __:__�------------- ------ ------------------- 1 J' Water Supply: Public'system ❑ Community system ❑ Private Dd Depth to Water Table y�_ ft, :- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑_ .Clay ❑ Adobe, Hardpan ❑, , Previous Application Made: (If yes,,date--------------------) 'No ❑ New Construction: Yes ❑ NOX FHA/VA: Yes ❑ No ❑ F *-TYPE,OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) At •,,. St'c Ta+ik Distance from nearest well____-__________Distance from foundation___________________Material-____________-___.-____.__________-_,-.__..____. ' No. of compartments------------ Size-----••--------- Liquid depth--------------------------Capacity---------------------'-- D s I Field: Distance from nearest well---- .-___-..__Distance from foundation____________________Disfiance to nearest lot line___________-_ ��. Number of`lines=_�_____________ ------Length of each line_-----------------------------Width of trench--------------------------------=-- 1 U� Type of filter material----.___.____-_________Depth of filter material________________"!__._Total length_:,____._____-___:__..__________.______�_. ' _ 1 Z74------- Distance Distance-ff m foundation-_ le —Number e Pit: Distance to nearest well ..�_�_______Dista�� to nearest lot line______._____._. yNumber of its'___:_ -Linin material__ _C ---Size: Diameter--- ? .-..__.___.Depth-------- _ ________-.__ Cesspool: Distance from nearest well-______-_____:_Distance from foundation--__._.___--_"____.Lining material-------- ---------------------------- ❑ Size: Diameter- -------------" Depth_ ------ -----------------------------------Liquid Capacity- --------------------------ga s. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----.-._____---____-______--------------. ❑ Distance to nearest lot line------------------- ---- ----------------------------------- ----------------------------' -------------- Remodeling and/or repairing (describe)=------------------------ - ---•--------------------•-•---------------------•- •-------- i ----=-------------------------------------------------------------- - --------"-------- --------------------------•i--------------------------------------------------------------- ---------- 1 I hereby c rtify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, at laws, and rules and gulations of the San Joaquin Local Health District. __------1__ _________________ Owner and/or Contractor (Signed)---- ---- - - '( / ) g 1 i � _ •��/L-- --'�•,j---- Title -- (Plot plan, showing size of lot, location of system:in relation to wells, build'tt�s, etc., can be placed on reverse side). r f FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY. Q ----------------------------------------------------- DATE ' _- _ ----------`- ----------- - REVIEWEDBY------------------------- F-------------------------------------------- -------------------- DATE--------------- TE -------- { I BUILDING PERMIT ISSUED - �� TE. :+ Alterations and/or recommendations:__ ___ -- `J�� -- ----------------- - ---- -------' -------------- - -� ,e.a - -- -------- -------------- ---------- --------- t . ---------------------------------------------------------- FINAL INSPECTION BY:----- _- ------ --- - ---- ---------- , Date-- SAN JOAQUIN LOCAL HEALTH DISTRICT ]601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,CaliforniaLodi,California Manteca,California Tracy,California , 1 ES 9 REVISED ,-.e 314 3-'63 F.P.CO- 'r