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FOR OFFICE USE- --------------I----------------------- ----------- - ---- APPLICATION FOR SANITATION PERMIT Permit No. 2$213e�� --------------------------------------------------------- -------- -- ------------------ --------------- ------------- (Complete in Duplicate) Date Issued --------------I------- ------------- This Permit Expires I Year From Date Issued 0? 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. Ro r K q -15-40------------- -------------------I------- JOB ADDRESS AND Owne�'s Name---6--OlUtl— -------if--- -------------------- --------------------------------------- Phone------------------------------------ Address-------\JU4_4 -------------.......(---------------------------------------------------------------------------------------- -------------------------------------- ------------------- Phone.--- ----- -------------------- Contractor's Name-------------/*�V_ Installation will serve: Residence @Y-'A'partment House El Commercial E] Trailer Court [3 Motel E] Other El 'sizeA 'e — -------------------------- Number of living,units: _/--- Number of bedrooms og--' Number of baths 70�._ Lot ---041'40! k 10 Water Supply: Public system E] Community system [] Private E"IDpth to Water Table /0- ft. Character of soil to a depth of 3 feet: Sand E] Gravel'0 Jr,Sancly Loam �Clay Loam El Clay [:3 Adobe El Hardpan ❑ Previous Application Made. (if yes,date____________________) IN 6.�New Construction: Yes E] No WRO"FHA/VAt Yes [I No ZI _�I�E OF INSTALLATION AND-SPECIFICATIONS.. R_4eef.r___ (No septic tank or cesspool pe' v- i a6le within200 permitted if public sewer is a a . 0 Septic Tank- e' Distance from nearest well---------------- Distance from foundation` ' 14 --------------------Material---------- ------------------------------------- - --No. of compartments..---------- ___SiZe....L......`------.------""-------Liquid depth----------- -- ----------Capacity_--------------------- DISLDosai ,Field: Distance from nearest wOAP�_ --__----Distance f-rom founclafionAko----------Distance to nearest lot lineAv----** Ir 'each - 'i ___;Z ---Widtk of french ________ __ of lines-------/------ Length of`each ---- -------- -- : ep of�-filfer material__ ----------- Type of filter material- D -----Total' length ---4e_ 2_49__ y t0rom founda o 70 Seepage Pit: Distance folnearesf well--_=__... ......"_ D i Jai n' ti n- ------------------Distance to nearest lot line______________"- ❑ Number of pits.___________________ Size: Diameter-----------------------Depth-.---------------------------- Lining material___- ------------ e. ------------- Cesspool: Distance from nearest well------------- ---Distance ji-om.founclatic'n--------------------Lining material-.____,_______"____ 01Capacity----------------------------gals. �5, Size: Diameter-------------------- ----------•-----Depth--------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, El 7 Privy-. Distance from nearest-well----------------- -------------------------------Distance"Ircm nearest building--------------------------------.-.------. Distanceto nearest lot line-------------------- --------------------------- --------------7----------------------------- -------------------------------------------------t, �J r Remodeling and/or re/pa ing (describe):----- - - - ------- ---------- ------------- ------------------------ -------------------------------------------------------------------------- ---------------------------------------- ----------- z-------------------- ---------------------------------------- ---------------------------------------¢-------r------------------------------------------------------------------------ ------------- ------ ------------------------ _.-:=------------------------------------------------------------------ -------------- ----------------------------------------------------------------- -------------------------------- ---- ------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County AV W_ ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. (Signed)---- M - - - - -- - - ---- -- - --------------------------------------------- Inums; a ayw Contractor) . ............ _�o --------------------------------- --------------------- (Plot plan, showing size of lot, location of ern in relation to wells, 6uildings, etc., can be placed on reverse.side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -------------------------------------------------------------------- DATE----------? k7----------------------- ------------------------------------------------------------ REVIEWED BY------------------------------------ ----- ---------------------------- DATE ------------- ----------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------I---------- DATE-------------------------------------:--------------_----— Alterationsand/or recommendations:------------------------------ -----------—---------------------------------------------------------------------------------_----------------------------- ----------------------- ------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ---------------------I-----------------------------------------------------------------------------------------:------------------------------------------------------------------------- --------------------- ------------------------------I---- ---- ---------------------- --------------------I-----------------------------------------------------------—----- ---- ----------------------- ------------ -------------- --------------- - ----- ------- -- ----------------------------- - --------------------------------- ------------------------------------ ----------- r - ---------- FINAL -I N S P I-C-fl ----- --- -- Date-. ------------------------z - ° -- % USAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltom Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California aLoBi,California Manteca,California Tracy,California ra 9 REVISED B-59 MM 3-'63 F.R.00.