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l`-UK (A-HCE: USE: -- ------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .__�.71�. � ---- ---------------------------- --------------- (Complete in Duplicate) Date Issued ..1��1 - is 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 N . 5 9, JOB ADDRESS AND LOCATION ---I-1 a -fl(. � i J Owner's Name - --- ---------/------- ---------------- Phone----------------------••---------•-- 9----------------_-- Address-------- --- ----------- --------------------------------------------------------------- Contractor's Name ------ Phone-_------------------_----- .Installation will serve: Residence Apartment Ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms __ _ Number baths _ Lot size ------ Wafer Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table?._._____ ft, Character of soil to a depth of 3 feet: Sand I] Gravel ❑ Sandy Loam E] Clay Loam ❑ ,Clay Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date___.___-.._._._._..I 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.) J r Septi Tank: Distance from nearest well__ __��___-------Distan e from foundation_____J.Q___-__.Material----_. No. of compartments___ Size___ !65C_j"�"Liquid depth_y-�_________________Capacity__.—O. _ - ------------ p d: Distance from nearest ell....` Q._� Distance from foundation-___ II r 1_Q_------.Distance to nearest lot line-- Number Number of lines ------------ --------Length of each line_____-___ �r i ----��----Width of trenckl-------�- ------------ is ie Seea pit Type of filter material---�„��_--s Depth of filter material_.____ ____.__Total length-------- *--------------- LA p Distance to nearest well_-__.__�� ____Distance fr m undation------1149 ____.Distance to nearest lot line ___-�r�___. Number o$ pits.._.---------Lining material-�;% --.Size: Diameter-------r �.___--Depth--- ---,�-------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____-_-_-__--__________________.____. ❑ Size: Diameter---------------`-=-_--- ------Depth----------------------------------------------------Liquid Capacity- -------------------------.gals. Privy: _ Distance from nearest well _________________________________._______-.----Distance from nearest building---------------------------- ---- ____.__._. G ❑ Distance to nearest lot"line----------------------------------- -------------- -------------------------------------------------------------------------------------------- ]b Remodeling and/or repairing (describe):__. '------------------ ------- ------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ --------------------------------------------------------------------------------------------------------------- I hereby certify t have prepared this application and that the work will be done in accordance with San Joaquin County 11 ordinances, State IaVK a7l rules and regulations ofTfa Joaquin Local Health District. 11 (Signed)------------------- -- . ---- ---- --- = ----------- - - --- -- ---------------------------------------•----- - d or Contractor) By------------=- (rifle) - (Plot plan, showing a of_lot, location of system in rells, buildings, tc., can be placed on reverse side). P FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ Y REVIEWEDBY------------------------------------------- - ---- ---------------------------- ---------------------------------------------- DATE BUILDING PERMITISSUED----------------------------------------------------------------- ---- DATE Alterations and/or recommendations:__-� ��-+ �,.r`.t.-----/-/��-r/-•�-`,�- •- '' !`x ` _ i� ________;F_t�-- _ _,Olf,-__ _ ---------------------------------_------------_-------------------------_------___---------------------------------••-------------------------------------- .•_._____ ------------- _ ------ -------- �- e- ' ----- --•----------------•--------------------------------- --------------------------------------- -----------------------------------I----------------•-------------------•------------------------------------------------------- FINAL INSPECTION BY ------------------------- Date-- P_'f _T _ .. c� SAN JOAQUIN LOCAL HEALTH DISTRICT (a 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F,p,CD. \t