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FOR OFFICE USE: --- -- ---------/4=I ---------------_---------------------------- ----------- 'APPLICATION FOR SANITATION PERMIT Permit No. .1__ _P...�. -------- ----'---- ---------- - ---------------- (Complete in Duplicate). z This Permit Expires 1 Year From Date Issued .Date Issued A91 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereirri•described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION._---�--4---J� )_(__ 4 Ff --------------------------------------------------------r. ---•-------------------- Owner's Name---- - -- ------- -------------- Phone------------------------------------ Address---------- - tca Ct/ ----- - - -- - - - - - Contractor's Name. --------------•---------------------------------------•------•-•---------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] Motel F] Other E]Number of living units: -_ __/ 'Apartment bedrooms ___r' Number of baths ,1--_ Lot size ------------ 7 _._1�57J_ 'u -________ Water Supply: Public.-system ❑ Community system ❑ Private 2a—`Depth to Water Table ft. Character of soil to a depth of 3 feet: i Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: {if yes,ddte... ...............) No � New Construction: Yes ❑ No F9' FHA/VA: Yes ❑ No F!t— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well-----------------Distance from foundation-------------------Material------------------------------------------------- No. of compartments ------ Size-------------=-------------- p _ Liquid depth--:-�---- ------------- Capacity----------------------- Dispos )Fie*/' Distance from nearest well..APP--------Distance from foundation,!P--_-__-__-_.Distance to nearest lot line.s_a__� ❑ Number of 1_/---------------------- of each line___ > C�.`..___._____---.Width of trench__ _ __�'__-_-__----___.____ Type.of filter material._ 4_G�l'_-..---Depth of filter material_2�`'_---------------------Total length---_-YP--`--:--------------__---__-. , Seepage Pit: Distance to nearest well_._360--------Distance from foundation_-f 0--f-_---_-_.Distance to nearest lot line-'-�-- ---------- --- ----_ _ [ f Number of pits--.,'__-____ _-_-_-Lining materia�k.C_�-----.Size: Diameter--_-�_3_ .........Depth--- � ' 2-�------------- ------ Cesspool: Distance .from nearest well-----------------Distance from foundation----- ------------- Lining material-_-_-.._..---__-_--.----.._---___-_- ❑ Size: Diameter-----i- ------------ ------Depth----------------------------------------------------Liquid Capacity-------------------------,--gals. F - t Privy: Distance from nearest well------------------______.___------.__------ Distance from nearest building____..._____-_--_______________.___._._. ❑ Distance to nearest lot line--------------------- -------------------------------------------------- Remodeling --------------------'-------------------------Remodeling and/or repairing (descri 0)--------------------- ! l ---------- --------- -------•---------------•------------------------------- --•--------•-------------------------- --------------------- -----------------------------I----------------------------------- ------------------------------------------------ --------------------------------------------------- -----------------------------------------------------'' ------------------------------------- ----------------------- ----- I 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 yules and;regulations of the San Joaquin Local Health District. S 7S (Signed)----------------- -- - -------- ------------------------------------------------------------------------(Owner and/or Contractor) BY ---------------- -------•---------------------------------------------- (Ti+le)--- - Y (Plat plan, showing size of lot, locationfof system in'relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.._.. _ _ - ---------- ------------------- DATE--- REVIEWED BY------------------------ ------ -- - -------- -------------- ------------------------------------------------------- DATE---------------- ------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------- -- ----------- 4DATE---------------------------- Alterations and/or recommendations:--�"-I -._- -- ----- ------------- -------- ----------------------------------------- ------------------__-_----------------------•-------------------------------------------------------- ----------------------------------- ---------------------•----------------------------------- ------------------------------------------------•---------------------------------------------------------------- -------- I ----------------------------------------------------------------------------------------- ------ --- --- --- ----------------------------------------------------•--------------------- -------------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTIONBY: + �---- ---- ------- ---- ---- Date_ .' y ' P`. SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CO.