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FOR OFFICE USE: ------------------------- ---------- -------------------------_------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .,Z.fl .r�..- - ------------------------------------ --- ---------------------- ---------- (Complete in Duplicate) a ¢ ------ - ------------ -•-•---------- - - - -------- --- This Permit Expires.1 Year From Date Issued 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.a plication,is made in..compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION ... -- Owner's Name----- --------------- E Phone---------- ------ Address.--------�J t --• . -------------------- -••---- ---- - :-.--------------------------------- Contractor's ------•- ----•• •- Contractor's Name . • . -a--• -------" ---- -- y Phone_A I ---- ------------ ---------•--•-- Installation will serve: Residence Apartment House ❑. Commercial Trailer Court i ❑ ❑ Motel ❑ Other ❑ - Number of,livingunits: ---_ Number of bedrooms _ gk10 -- Number of 'oaths .-�_-- Lot'size ,r.?____✓� .�Z)------- ---------------_ r r Water Supply: Publictsystem, ❑ Community system ❑ Private Depfh to Water Table -------- ft. . Character of soil +o a 'depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay . ❑ ❑ y ❑ y ❑ y ❑ Adobe (Hardpan ❑ Previous Application Made: {If yes,date......_ t ) 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.) - L Septic ink: Distance from nearest weft---- r1__._-Distance from foundat n__.E_O--__--.--.Material--- .__ No. of compartments_.__- . Size__yy��....�a I `t^ x Liquid depth !j -Capacity_ O__ Dispos Field: Distance from nearest well.... �--_:Distance from foundation----1..0_t......Distance to nearest lot line_*37---____--- N Number of lines-------- +_ _ -- 4-7------i-=-- .Width of trench--'--"�- Len —..Type of,filter, material--_� � offlter material------/�----------Total length__- :�_---------__----------- -- See Seepa Pit: Distance to nearest well Distance from oundation__� - (___.___Distance to nearest lot line ....... " --Number of'pits - p _ -- ._---Lining material:--, _ f'__$iie: Diameter_-.---��-'r ..Depth------ - ---:- Cesspool: Distance from nearest well-----------------Distance from foundation.-..____.-----------.Lining materia)-_1.____-- ❑ Size: Diameter--- ---------------------- --------Depth---------------------------- Liquid CapacitY_.:. gals. T Privy-❑. Distance to nearest lot I nle_'s _--__ _: Distance from nearest building _ -_ ,_ Remodeling and/or repairing. (describe] . "' ' --- --- •-- ------ ------ r = =------------•------------ - --------- ' -----`--------------------------------� } -- �� -------------------- -- --------------•------- -a - - - I hereby cerci that I have re ar'ed,this a licafion and_that the work will be done in accordance with S ----------------------- P P PP an Joaquin Coun+y ordinances, Sta a la s, and rules and reg s of the San Joaquin Local Health District. y 6 i 1 (Signed} ---------- } f --------------------- By: ----------------- = - ; t ridContractor)A ` r , BY: --- ------. . -.:. - s �o ---- -------------------------------------------(Title)--------- --'--------------------------- l (Plot plan, showing size f Iat;location`of'system.in.relafi fieto wells, buildings„etc.,_,can-be placed on reverse side). FOR DEPARTMENT-USE ONLY APPLICATION ACCEPTED-BY--Q.-.-- ---------- 1 ------------------'DATE-----1--6..___.___7_t 1-------------------------- --------`--------------- --------------------REVIEWED,BY--------------•------------------ -- ” jj DATE }- BUILDING PERMIT455UED ';,';;------------- `----------- �-•---DATE------------------------- f Alterations and/or recommendations:_ 1[?__..� ]..•_ -4- ' ' Tj_ytis t ------ ---------------- i^ - - --- -- ------ •__•_•--•---------------------------------------------------------------------------------------- t . = --------- FINAL INSPECTION BY: _ - Date------- SAN 1 i } JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Maxeiton Ave. 300 West Oak Street .12 4 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California [5 9 REVISED B-59 3M 3-'63 F.P.DD, . r S�