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OR OFFICE USE: ------------- ----------- ---- -----------------),1_30 APPLICATION FOR SANITATION PERMIT Permit No. ------------------- --------------------------- --------- (Complete in Duplicate) Date Issued ----- ------------------------- --------------------------------- This Permit Expires I Year From Date Issued Y Application is hereby made to the Son 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. D 'One ---------------------------------------------------------------------- JOB ADDRESS AN OCATION.. E .Owner's Name---...0 W_ ...... 7$� Address----------------- Contractor's Name-.--=•------ .---. P h o n a-//,0 A641607 IResidence iX El Apartment House Commercial E] Trailer Court El Motel E] Other I-] 4P ---- 'Installation will serve: Number of living units: Number of'bbdrooms _2,__ Number-of baths ---/--- Lot size ...... -4.0. .............. ----------- Wafer Supply: Public system Community system ❑ private E] Depth to Water Table AV- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam 0 Clay E] Adobe 1Z Hardpan rj Previous Application Made: (If yes,date--------- ----------) No Dd New Construction: Yes X No E] FHA/VA: Yes ❑ 'No [9 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank-or-cesspool-permitted-if-public-sewer--is-available within 200 feet.) Septic Tank: Di�fance from nlearest weIlA/4PNe__Distancq from f6undafion__-4Y,0'2' 7-----MateriaJ__/_':?f �01-V___l----------- �4 'f - N6. of compart6rifs--------:*.L--- -------- ._._....Liquid depth - ---------CapaCJTy__ZFC,__W_ i f t. 1. ---7__ � Disposal Field: Distance from nearest wel I_1YCA4FD i stance from f6undafion....I.d?_!------Distance to nearest lot line---- Nymber of lines------------/--------------------Length of each line----------o6_0------------Width of trench-_-._-___- _ ---------- T 'p e.of filter Depth of filter 'Material-------/AS--*-----Total y _length__._______________----ellb!l------- Seepage Pit: Distance to nearest.,WeIW61W-49�-.--Distante from fo'undafion---le.>.. ......Distance to nearest lot line--LM-------- Number of -----------Lining material__R.0CJ<_ -Size: Diarnefer--------$0---------Dept h----- -f---------- Cesspool: Di t stance from nearest well------------------ istance rom oun ation-- ---------------- Lining material-------------------------------------- El Size: Diameter ------------------------------------Depth-------------. J Liquid.. Capacity_.-------------------L-gals. -----------------I---------1-1------ Privy: DiYance from nearesf1w;IP__-..'j.jr ------------------------------------ ---Distance.from nearest building--------------------------------- ❑ Distance to nearest lot line------------- ------------------- --------- ----------- -------------------------1 � I --------------------------------------- ----------- Remodeling and/or r,pairing --------W-AFAV-_1-----I 57F4 lew -----------------------------------------------------i---- ------ ----------- -t---------------------- ------------------------------------------ --------------------I - ---------- ----------- ------------------------------------------------- I # :------------ ----------- ----------------- ------1-------------;1------------------------------------------------------------------------------------- ------------------- ------------------------------------------------------ ------------------------------------ ---------------------------------------------------------------------------- ------ ------------------------------------------------------------------------------------------ I hereby cerfify that I have prepared this application and that +he work will be done in accordance with San Joaquin 6ounty ordinances, Sf'afe law'kS! and rules and regulations of the San Joaquin Lo'cal Health District. ---------- (Signed ...... . ----- (Oviner and/or Confracfor) �_,------------------------------------------------------------------- ------------i,.------.[O ----------- --------- By: ---------- --- --------------------------7----------------------- —----- .............. ------ -system------------- -(Title)--------- ----------- ----------- ]an, showing siz; of lot, loca (Plot p �Zon In relation to wells, buildings, etc., can be placed on reverse side). 4 � —FOR-DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------/,_t/ DATE n�mIi_.Z__'__-�7-- -- ---------f----------- ------ ------------------------------ ------ REVIEWED BY---------=---I 'f_14 C%�t�o --------------------------- --- -----------------------------------1- ATE---i------------------------------------------ BUILDING. DATE.-'----- -- ----- -- ----------- ---- ---------- Alteralionr ---------------- ---------------------------------------------------------------- ---------------------- -------------------------------------------- -------------------------------------------- ------------ ----------------------------------------------------------------------------------------------------------- ----------------------------------- ---------- -------------------------------------------------- --------------- ----------------------------------------------------------------------------------------------- ------------------------------- •-------------------------- t---------- --t-------------- I-------- ---W----------------------------- -------------------------------------------------------------- ------------------- ------------------- f - ----------------------- FINAL INSPECTION BY:-......------ -------- ------ ---------------- mate----------.--------- -------------------------------------------------------- S;VNJOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F-P,Co.