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FOR OFFICE USE: :i ------- Permit No. --------- -------------------- APPLICATION FOR SANITATION PERMIT --- -----"-" - _. -------- ------------ (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and -install the work herein describe This application is made in compliance with County Ordinance No. 549.'.- A 49.'. � "JOB ADDRES AND L TION---------- - ------- -•, --""" Q� Owner's Name------------- - -- ------- Address ...- =--"-------------------------=- - ---- --- Phone_.. - I Address_____________ ___ � --------------- -- `4_Q = bQ4 i, l -------- Phone----------------------------------- - Contractor's Name--------- ------------ --------------------------- Comiercial ❑ Trailer Court ❑ V/otel Other ❑ Installation will serve: Residence � Apartment House ❑ � , Number of living units: _ --__ tuber of bedrooms__- Number of bathso .size ___._ oZ-_-,- fL ' -------=---------------- 11 Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table . "" ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sand Loam El Clay Loam El Clay ❑ Adobe ardpan ❑ Previous Application Made: (if yes,date._-----------------I No w Construction: Yes No ❑ FHA/VA: Yes LeJ" I"O El l TYPE OF INSTALLATION AND SPECIFICATIONS: I ' permitted if public sewer is available within 200 feet.) . (No septic tank or cesspool p p Septic nk: Distance from nearest well---- --Distance from foundation__.��=�'�---.Mat�rlal_�t°: --�--L:------------�- ---• Size_. ' q R ----Capacity----JNO_- - Na. of compartments__----�.�------ - •-�-� -------Li Liquid de1th__�------------ f 1 t _ Distance to nearest lot Disposal field: Distance from nearest well ""----_Distance from foundation_=_/ Number of lines------------------------ Length af;eacl line___--�C2j-j-/ --.-.Width of trench.__ -_ ."------------------ YP /� filter material------ 9-_J=---.Total length____ - ------------------- P �f� �-- t: D stanocefto nearest swlell_-- - Distance f f� _. om foundatson�� >.____.___Distance to nearest lot I�s__ See ps i Number of pits---r3. .�--------Lining material__ ---.Size::.Diameter-___ _. _"__.Depth_O� ___ -------- Cess Cesspool: Distance from nearest well_____--______-Distance from founclatiof, _---__.___.Lining material.__._..______--__._______________. N I P y _Li uid Capacity----------------------------gals. ! ❑ Size: Diameter------------------------- -- Depth --- - ---- ----------- P Y m nearest lot line-----------------------------------__``-- _l is#a rice from nearest building----------------------•------------------ of I --- Privy: Distance from nearest well------------------------------ Distanceto - ------------------------------------- -------------------------- j • Red w- - - ------------------------------------------- i.ln j.r repainng (describe): ,, ---------------------------------------------------------------- y -- v ~ � , v----------- --- -------•--- --- a �: }c ! hereby certify that I �tave prepares this pea 1. nd thi t tile' a�l�wy be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of ,+ an .l..oequm ealth District. and/or Contract (Si ned - -------------- ti - { * ----------- ---------- ,� -_-, s� ---- Title)" £ _ By:. = : ._ (Plot plan, showing size of lot,'location of system in relation•to wells, buiidings,.etc.,.can be placed^ s*� 1�8 < d e)�` FOR DEPART-MENT.USEONLY- --y DACE A 7/ APPLICATION ACCEPTED BY_."_._ .: ---" --- - re_ ��C„� --------•-----._`DATE:------------------ ------------ --•------------------- REVIEWED By........................................ ------ --------------------- -- "" DATE------------='--_------- . ----- BUILDING PERMIT ISSUED--------- ------------ - ---- --- y�-` ; -r Alterations and/or recommendations:: ---------- ------------------------------ ------•---•------ - ----------------------- .. _______________________ M1�, ____________________________________ ___.__._____- FINAL INSPECTION BY:. . --- - - _-, -"�'e ------------ - Date_l__ - ------------q .q------------------------------------------------------ SAN JOAQUIWLOCA HEALTH DISTRICT 1601 E.Hazelton Ave. 300 west Oak Street 124 sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P-I3C