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FOR OFFICE USE: 1 -------------------------------------------------- rr APPLICATION FOR SANITATION PERMIT Permit No. _�..11.. ------- ----------------------------------- ------------- (Complete in Duplicate) Date Issued .___________ .�y% --• =- ------------------------------ This Permit Expires 1 Year From Date Issued y_ Application is hereby made to the San Joaquin Local Health District for ap o•cons#tact and install the work herein desc, This application is made in compliance with County Ordinance N . 54 `°2 - --- -- y JOBADDRESS ANDLOCATIOg-- - - Owner's Name----- ---------------------------------------- Phone—//D--- ----+Q Address ----------------------------------------- r --' � r----------- Contractor's Name - ?�oU-Dfo Phone%&..-��. Installation will serve: , Residence X Apartment House E] Commercial E] Trailer Court E] Motel E] Other El{ .�. . Number of living units:_____ Number of bedrooms _ _ Number of baths _ _____ Lot size®® 'd-- --- - --------- ------ - - Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table �!'_Q- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [:] Sandy Loam Clay Loam El Clay ❑ Adobe ❑ Hardpan [I Previous Application Made: (If yes,date._-.-------------- ) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No El !� 4 TYPE OF INSTALLATION AND SPECIFICATIONS: r f + V ;I r (No septic tank or cesspool permitted if public sewer is available founda?oO feet.) -sry Material__.___�___________________________ _______'`��l e -crTank: Distance from nearest well-_______________Distance No.-of compartments------------- - ----------Size---------------•----------------Liquid depth------ ---------- ' Capacity--•------ -------- Dispos Field: Distance from nearest wel1.E4_--_*Distance from foundation.a?42_-_______.Distance to nearest lot line___�!Q.--- -Length of each line___ Number of lines----- ------_---__._-- _- -A_40-_4,j------ of trench- - _. Type of filter material z'A aaCV----Depth of filter material____,�S_- ________Total length!___________________ ----_---- 9 Seepage Pit: Distance to nearest well__ -------------------Distance from foundation--------------------Distance to nearest lot line_-.____________-:`�� ❑ Number of pits----------------------Lining material-----------------------Sizl: Diameter------------------------wDppth----------------s---------- -- Cesspool: Distance from nearest well-----------------Distance from foundation -..------------_--Lining material--------------------I-_______--______El .,� Depth-----------------=----------------------------------Liquid Capacity----------------�--------gals. Size: Diameter - _ t. r., Privy: Distance from-nearest well-------------- -- --.---------------------- ----Distancelf�rom nearest building------------------------.-.---_-------= f ❑ Distance to nearest lot line_________________ i ------------------------------------ - ----------------------------------- Remodeling and/or repairing (describe):___Z�---;-- -- -- - ------- ------------------------- ---------------- f i ------------------- -----------------------------------------•- --------------------------------------------------------•----•-•-------- ----------------------------.._.---------- - I Y Y prepared-----------------------------------PP 9 _41;1 f, == ordinances, S+a a laws, and rules and regulations of the San Joaquin Local Health Dis ne in-accordance with San Joaquin County 1 hereby certify that I have re ared this application and that the work will be d trict. �ij2Ci a _ _- (Owner and/or Contractor) 5i ned ......... -- --- { 9 - ---- - -- -- - BY� - ----- --- ---- = `------- -{Ti+lel f" --- ---- ---- ------ -- ---- -- -- ------------- - --- - (Plot plan, showing size of lot, location of system in relation tow , Buildings, etc., can be placed on reverse side] FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - --- -- -------------- ------------- DATE------------- --- -------- --- - -- - -�" ---------------- �� REVIEWEDBY----------------------------------------- --- --------------------------- ----?--_---------------------------------------- DATE--------------- ------------=-- ------------ BUILDINGPERMIT 1SSUED-------------------------------------------------------/- ---------------------- --- -- ---------- DATE---------------------------I---- --- Alterations and/or recommendations:--------------------------------- -/.--------------------------------------------------------•------------------------:/---------------------------------- ----------' ---------------=----------------------------------------- ------------•---------------------------------------------------------------------------------------------------•---------------------------------------------- ----------L------------------------------------------------------------------------------------------ --------------------•----------------------- ------- ------------------------------------------- ---------------------------------- ------------------------------•-•------- - - ---- - -- ---------- FINAL INSPECTION BY--------------- � -------- Date---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Stet 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Es 9 REVISED 8-59 3M 3-'63 F.P.CO.