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FOR OFFICE usE: -------------------------= -----. APPLICATION FOR SANITATION PERMIT Permit No. l2(--7 `---_- ------- ---------------------- -- ----- --- (Complete in Duplicate) . This Permit Expires 1 Year From Date Issued Date Issued .l�_�1�'�� 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. _ �N 'N4 � } r.• P JOB ADDRESS AN -LOCA l0 �--- - ------------------- Phone----------------:---------- Owner s Name _ - --------_---- ----------------------- --------- 1 � � , I Address---------•- ----E__ r �--- - -- ---------------------•----------------------- Contractor's Name---------- •__-- __t------ ---------------------- .:.--------------- Phone---------------------._..---------- Installation will-serve: i Residence Apartment House ❑1 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ; 7-1 Number of living units: _f._. Number of bedroom___ Number baths _`� Lot size _______ __`-_ _.._____ _:.: r ---------------- Wafer Supply: Public system ❑ Community system ❑ Private Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: . Sand ❑ Gravel.❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made: (If yes,date_.._.-__-- _�..___1 No ❑ New Construction: Yes ❑ No ❑ PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATIOWAND SPECIFICATIONS: (No septic fanVe'r cesspool permitted if public sewer is available within 200 feet.) t Septic ank: Distance from nearest well,_ _d_.�Distanc�e�o Jf4�ridaf,0 _._____�a'___-_M�erjal----_- _. __ No. of compartments. ` `:._—_ _:.Siz _��___�__ ___�/._.__==:, L-iquid-dep-th___________________...__Capacity__- 2 _d I �� foundation.-'la \ Dispos Field: Distance from nearest well___-�_..._D.�s Wince from ___..__Distance to nearest lot 1�e_�_________. ._..._ .. -- Len th ofweach.line_.-_ Width of trench---------------- Number ofFlines--------' g _. it f --" Type of filter mateeiaL1_ -------------Depth of filter material...../P-___.______Total length____a 0_____________________.- . r�D i w -(..___.Distance to nearest lot iine_x--------- Seep/ Pit: Distance tom crest.well-- ,�________________Distance f o f-ou dation___l_ g It _ Number cf;pits._..�_ --------Lining materell, ial---- -__---- �] ---------Depth---z` --------------------- Size: Diameter__._. Cesspool: Distance from nearest'w6l-----------------Distance.from foundation---.---------------.Lining material-------__._._______-_-___________. l ❑ Size: Diameter------------------------------.. Depth----------------------------------------------------Liquid Capacity- - ----------------------•-gals. Privy: Distance from nearest well_-.---.--_-_f---______-_------------------------Distance from nearest building________.__,_______________-------___._. ❑ Distance to nearest lot line------.----------------------------------- ----------------------- -------------------------------------------------------------------- ,:Remodeling and/or repairing Idescribe):--------- --------_-------------------------------------------------- ------=------------------------- ..rr" ----------------- ------ -------------------------------------------------------------------------------------- ----------------- I hereby certify that I ve preparred this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, r s and regulatiefrelafion San Joaquin Local Health District. . and/or Contractor (Signed)----------------------- -- •------------ - ------- ------ ----------�--------=------------------- ----------- -----------�- 'e-'. � ) . 94 - BY:--------------- - •-•-• - ------ -------•---------------- -- ---------{Title}----------- - ------ ------ --------- - --------- -- (Plot plan, showing size of lot, location of,sysfwells, buildings, etc., can be placed on reverse side). FOR R DEPARTMENT-USE ONLY ------ DATE___ ----- ZV � --/_Z. ------------------ ----- ---- �). APPLICATION.-ACCEPTED BY--.-- --------------------------------- REVIEWEDBY------------------------ - --------------- - ------------------------ --------=---------------------- DATE BUILDINGPERMIT ISSUED-------------------------------------------------------- = - ---- DATE r,Alterations and/or recommendations:--------- --------°------------------- ----°-- ----------------------------------------------•-••------------------------------- #-----------------• ----------------------•------------------ - --------------------------------------------------------•-----------------------------•- -------------------------------------- --------•------------------ ._... q -------------------------------- - ----------- ------------------ ----------------------------------- ------ ------------------------------------------------- — - — --------------------------- ---------------------------------- ----------------------------- a r � 4 i FINAL INSPECTION BY:_. _ , ---------------- Date �� -�r ------------------ -----------I---------------- SAN ------SAN JOAQUIN LOCAL HEALTH DISTRICT 1 1601 E.Hazelton Ave. 300 West Oak Street 134 Sycamore Street 205 West 9Th Street Stockton,California Lodi, California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-63 F.P.CO. 1