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FOR OFFICE USE: .................................---• ........ f ••--•............ ................ .. .. .. APPLICATION FOR SANITATION PERMIT Permit No. 1- --- 1--- ......................................................... (Complete in Duplicate)' atDate Issued 1.c-2—Ln0— ,65 ................................................ 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 No. 544. } 4 . } .JOB ADDRESS AND LOCATION---- --' t+ Owner's Name--------- _../.f!'�!1.t7n _. . _.....�y► .. Phane_.Q> ✓r: .. _. rj� . Address ,p_O!.... r�'7. .�� .---.....T.M.(xl• C�4L1PAN ! l-........................................--.....�-......_. Contractor's Name..__C..� �`_ �—..44,fi._.._L.�/ U _. --tr.._.. �:```'-Phone-.-f ��--.•y-............ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ 'M,(otel ❑ Other ❑ I Number of living units: -------- Number of bedrooms _,�.... Number of baths ........ Lot size -.//7-d.��........................•._ Water Supply: Public system V 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, , hardpan ❑ Previous Application Made: (If yes,date....................} No New Construction: Yes ( No E] FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well, Q.a.__.Distance from/foundation._f .......Material_ .�... _c=�........_....................... F-1 No. of compartments....._.. size.. ....._.....----Li9uid depth----�•f-----------•---Capacity_ Q + Disposal Field: Distance from nearest well-f-?_e-.5?_..Distance from foundation._3v_-___ t Zistance to nearest lot line.................. \ ❑ Number of lines----- .__....J____..._......_Length of each line.___.3� '1___... .Width of trench----- 2f......:................. Type of filter material-.L1- -S r .Depth of filter ma a1 int` .�f total length-.-- ,._,/._.�� p ` Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line.......--_....... ❑ Number of pits----------------------Lining material.......................Size: Diameter.......................Depth................................. Cesspool: Distance from nearest well.................Distance from foundation....................Lining material...................................... �) Size: Diameter..............-----------............Dept h....................................................Liquid Capacity...............-----.........gals. Privy71 Distance from nearest well.......................................................... .._...Distance- from nearest buil'ding___.--._--.----_-___________•_.__•-- 11Distanceto nearest lot line..........................-- -- ---...._..--••--•---•---•----•-•..._...--•-•----------•-------....•---•-.................._.--•-•- I Remodelingand/or repairing (describe):................. ._........--•-•-•-------.....•----•-----•......-•---....-----......._....-•-•--•.....-••••--------•--...._..•----_............... --------..........................................................................•--•-•-••-•-----------------•-•------......--......................................................................................... •t ...............................................................`z .._ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. 1 1 - (Owner and/or,Contractor) ...•... --....-------------------•-•---•--- .-... / By:...L-;-Ii— ti-r...... ................... ---------------------------------------••----._-.-------------..(Title}.. .._C ..... (Plot plan, showing sae of lot, location df s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r APPLICATIONACCEPTED BY------------------------------- ----------------------------------------------------------------- DATE.............................................. r REVIEWEDBY........................................ .................................................................................... DATE........................................................... BUILDINGPERMIT ISSUED............................................................_..................................... DATE............................................................. Alterations and/or recommendations:..._.........................•--.......----............._......._....... •-•---•-•--•-•--•------•-••-•-•-----------------------------------•---........... j .----•.........................................••-•--•----•---•--•-------------•-••---=-----•-•-----:---.......---...---...,............--------..............-•------...._.•-.........-.•-•••----••-......--...--- t •----••--------........................................... .....' ........... ...................... ' . . ..................__............_.......-•-•-•-•••.._....................---•..._............_............. .............•----.................................................................................................................................................................--..........................-........... FINAL INSPECTION BY:. .1. l`..�-' � Date �.. ....... .......t�.._5.........._. SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteta,California Tracy,California CS 9 Revises a-b9 3M 3-'63 F.P.Ca.