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FOR OFFICE USE: ----- ---- 1u)"7 APPLICATION FOR SANITATION PERMIT Permit No. --------- ------------------------ 11------ ----------------------------- (Complete in Duplicate) Date Issued sP----e_3.........�P- 7 -------------------------- ........ 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 des&bed. This application is made in compliancewith County Ordinance No. 549. 0C,,,S'--C 20--0 JOB ADDRESS AND L CATI N.__ .. l,�h .-- --0 __- Owner's Name ------ ------------ Phone-------'-----------------------•-- Address----•----- A5; --"r--- � ' Contractor's Name p--------------------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel)❑ Other ❑ a t Number of liv-sing.units: __/-_ Number of bedrooms ,,,?_ Number of baths __ Lot size . --'--------------------------^�^ Wafer Supply: Public lsystem_0 Community system E) Private �epth f, to Water Table 9- ft. Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ 1 Adobe ❑ Hardpan 4" s.Previous Application Made: [If yes,date-------------------?) No P' New Construction: Yes 24-'1qo ❑ FHA/VA: Yes [L_- No ❑l TYPE OF INSTALLATION AND SPECIFICATIONS:a 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-- -®---_-Distance from foundation---_ s�4-----Mate�l:,��.��`'� ------------ { A--:'_-3C 3L-,quid de th--.--�� - Ca acit ZZ�Q---- No. of compartments---- ___ .- Sizep. p Y � i Disposal Field: Distance from nearest well well---IX-0----Distance from foundation- - -------Distance to nearest lot line-��-_-- Number of lines_•,':%vt------ -Length.of each line-- �-Q-� Width of trench-�_1---------------'-_------ ,Type of filter materialz. l0 -Depth of filter material--- ,----------Total length-_ t ------------------------- i ��- Seepage Pit:. Distance to nearest well --_--Distance f�r m fou dation _______-_-. Is ae to nearest lot line------ ---------- r Number of pits---- ..__------Lining material-/ .---- Size: Diameter- ------------ Depth th- ---------- Cesspook Distance from nearest well------------------Distance frorn foundation....----------_-_-_.Lining materia' l-------------------------------------- Size:Size: Diameter------------------------------------- Privy--r Depth--=--------------------------------------------:----Liquid Capacity----------------------------gals. Priv Distance from nearest well._----__-__----.---------------------------------Distance from nearest building Y -- :. ❑ Distance to nearest lot line______ ____----------------------------------------------------------- a _____________�_.--- -_ ------�____-- ___-- j Rernode{ing and/or repairing (describe}: a&I .- � �...r�'�� ------ I I s ' ----------------------------------------------------------------------------------------r ------- ------------------------- ----•---------------•--------'-----------------•••-------------------------------•--•----------------------- -------- ---- - ------------ - -- ---- --.--- ------------------------------------ I -- ..- s I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws; and rules and regulations of the San Joaquin Local Health District. /'r --------�or Contractor) (Signed) - --------------- E`�/------ ------ --------- --- - - 9 ) gY� = � ------ - ---•------------(Title) [f ��' �---- - -- --------------------- * (Plot plan, shaving size of lot;;loca+ion of syste i relation to wells, buildings, etc., can,be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY��. --�-�------------ --=-------------------------------------------- DATE--- --------------- REVIEWEDBY----------- -----'-- ----------- --------------------------------------------- -------------------- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------- --------- DATE-------------------------------------------------------------- Alterationsand/or recommendations------------------------------------ --------------------•------------•--•-----------------------••-•--------------... -..--,------------------------------ -----•-•-- ---------- ------------------- --------------------------------------------------------------------------------------------------------------------------------------------•--------- •--------------------•--- Date-% "' .- FINAL INSPECTION BY:-_� -�7" � ------------------------- �--------------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eltan Ave. 4 300-w1V t Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-54 3M 3-'63 F.P.CO. .. ,. f tib"='•'s f