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FOR OFFICE USE: -�7--# 4 yffg" APPLICATION FOR SANITATION PERMIT Permit No. .. ------------------------------------- --- ---- ---------- Z94 ..... ------------------------- -- -- ---------------- ------- (Complefe 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 instal4 the work herein described. This application is made in compliance with County Ordinance No. 549. OSS- Lam--j3 JOB ADDRESS AND LOCATION --.-mo`'-d-----�'(�'��`,-'- .J� �`'-��""='1��•`�`'�r ��------�r� Owner's Name ------•- - Phone Address-------------q-� ------ 3v7� r Contractor's Name------ u _r-...� K '- -'``�'-' Phone .... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ff Motel ❑ Other ❑ Number of living units: -1---- Number of bedrooms.ZZ-.- Number baths --1 Lot size -_-_I� - ------ 1<- ----------------- Water Supply: Public system El Community system ElPrivate epth to Water Table --------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loamay.❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------- --------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet,) _ Sek: Distance from nearest well----�"O--- Distance from fib ndation�-.J ---------Material----_- ;- ----------- W u No. of compartments------'�.---------------Si � ze- �.. --- , ----Liquid depth---- ---------- ------.Capacity--,�, o � Disposa Field: Distance from nearest well...SP..i.-Distance from foundation -�-_--_-Pistancetto nearest lot line-- --------- Number of linesLength of each line-------. -------------------------- - - _ -_-------- -_ , - ---------------------- See �TYPe of filter material- - f-----De Depth of filter material--- ----- Total length----_--�'�e--_ -._-__-_-.--_ SeeePit: Distance to nearest well _ /�....-_Distance from foundation----f-0_�-_-_-Disnceto nearest lot line----------------- y Number of pits - ------ Lining material--,J.-e--,_------Size: Diameter--------�3- Depth----Vis.`---------------- p Cesspool: Distance from nearest well-----------------Distance from foundation ----------------Lining material----_.----.----_-_.___---_-------------------------------------- "s~ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----- -----gals. 6 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------_---_ ___----..--:.--." ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------- ------------------------- - 41 Remodelingand/or repairing (describe):----------------- ---------------------------••------------------------------------------------------------------------------------ ------------------- ------------------—-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- I herebgat that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, s, and rules and regulatioUe Joaquin Local Health bistric+. (Signed)------ --------------------- ------ --- ----------- --------------- - - -- nd/or Contractor) BY� (Tide) ----------- --------------- -------- -------------- r plan, showing size of ot, I atio of system in relation to well , uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --------------------------------- DATE---'F----IJ---4X------------------------------- REV ATE---'F--- J--rX------------------------------- REVIEWEDBY--------------------------------------------- -------------------------------------------=------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------------------ --------------------------------------------------- DATE---------------------- - -- ---------------------------------- Alterations and/or recommendations:----------------------------------------------------- ----------------------------------------•-------------------------------•------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------•------•--------------- -----•---------- ------------------------------------------------------------------------------------------ ---------------------------------------•------------------------------------•---------------------------------- ------------------ ----------- ---------------------------------------------------- ---------•-----------------------------•--------------------------------------------- ------ ------------- FINAL INSPECTION BY:- Date -------- _' T_ ---------------------------------------------- * SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Har:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED B-54 3M 3-'63 F.A.DD. • r Z -� $