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"-elo_ OFFI E USE: --.----; _- APPLICATION FOR SANITATION PERMIT Permit No. ----------- --------- ----------------------------------- (Complete 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 install the work herein described. This application is made in compliance with County Ordinance an �No. 5449. JOB ADDRESS AND LOCATION. _cX!- 1 L ,W --------------------------------------------------------• ---- --------------- r Owner's Name_______ r _ ------ Phone - --)- � ---- - ------ -------- Address_____________ _ 10 IS Contractor's Name--------- ---------••---�--�_104_ --------------------------------------------------------•--------..-_.--------------•--._. Phone----------------------------------- Installation will serve: Residence [B�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___�& Number of bedrooms ----T Number of baths _I—__ Lot size .1-6le-44---------------------------------------- Water Supply: Public system 0 Community system ❑ Private Depth to Water Table IQ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(Hardpan p Previous Application Made: ilf yes,date--------------------1 No e New Construction: Yes ❑ No K FHA/VA: Yes ❑ No [� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ank: Distance from nearest well________________Distance from foundation--------------------Material _________-___-______..__________------_-._._... No. of compartments--------------- - -------Size---------------•--- --------:---Liquid depth--------------------------Capacity----------------------- Dispo Field: Distance from nearest well_ -------Distance from foundation_A!--r_________.Distance 'to nearest lot line. ____.__ Number of lines-------------/ ___.-- --------Length of each line----Aa,------------.---Width of trench----_m-st,�®----------------- \` . d� Type of filter material'__ --t ------------- of filter material-_.�f_h____----_--Total length---_%P_ ____________________________ ~ SeePit: Distance to nearest well_40Q-------------Distance from foundation--/d___- ....... Istance to nearest lot line---�-�_.__ I G� -I --- ----Depth-----�---------- --- - Number of pits.__._./______.______fining material__�l�_C�____...Size: Diameter____ - - Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- El Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity-------------------------...gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearC.f building---------------------------------..__..._. ❑ Distance to nearest lot line----------------------------------------------- ----------------•-------------- ------------------------------------------------------------- Remodeling and/or repairing (describe)=--------------------------------- --------------•-------------------------------------------------------------••---------------------------------------- ---------- i r I hereby certify that I have prepared this pplicati n and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulat' s of t e San Joaquin Local Health District. (Signed)_------------------------------------------------------------- -----------------------------------------------(Owner and/or Contractor) BY� ---• . ----- ---- -- -- . - -----------------------------------(Tit le)------------------------------- -- --------- - (Plot plan, showing size of lot, coca ' o syst to relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ---•-- - -- ---- - --- - -- ------ -----------------------I--- --------- DATE--- -- ----- ----- -----7.--------------------- - REV - REVIEWEQ BY ------- ------ DATE BUILDINGPERMIT ISSUED----- •- ---------- -------------- ATE------------------------------------------------------------- Alterations and/or recommendations:____ 7__ r� ----------------------------------- --------------------------------------- ---------------------------------------- -------- --------------------------------------------------•------------------------------------------ --------------------------•--•--- ------------------------------ ---- ----------------------- -- t FINAL INSPECTI Y-- ------ ----- ------ Date.. SAN JO UIN LO L HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 13.59 31A 3-'63 F.P.CO.