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FOR OFFICE USE: i� --------------------------------------- -' '-- ---- Permit NO. /! _...... .---•--•- ------------------------------------------------------- APPLICATION FOR SANITATION PERMIT / ----- ----- ----------- ---------- -'-----�.----- .(Complete in Duplicate)- �Date Issued "---r�j<�--��--- 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 described. � N� lw t This application is made in compliance with Count Ordinance No. 549. i aGt a �� i _ - ------- �— - a JOB ADDRESS AND LO ATION_ -?x __lLfi` '�'•w-- --- ""---A-11.44-- Owner's Name_ _ - - -- -'--- �,,, r� - Address. ._. .5----•---•• --------------------- Contractor's Name-------- -------- installation -- - Phone.. installation will serve: =Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms _ Number baths _ ____ 'Lot size .w _ Water Supply: Public system [_1Cmmuriify system [I private Depth to Water Table ------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam [I Clay Loam El Clay [Adobe E] Hardpan ❑ ! Previous Application Made: (If yes,date _._.___7....... ...) No F1 New Construction: ryes E] No ❑ FHA/V Yes E]. No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: y ,; (No„sepfic tank:or cesspool permitted if public sewer is available within 200 fe t.),„ t Septic ank: Distance from nearest well-___, __I�_Distance from foundation___. -�__._ .MatenaL_____________ __________________________________ No. of compartments_..._.--.---.--'---Size �_�_��af_q�X_ '�Ligwd depth”-'---- --------------Capacity.__.�a _. . I " Dispos field: Distance from nearest well.__-__�f>_f:.Distance from foundation__.____JQ_`'_.Distance to nearest lot line_ _______..: pp _ -1 +f . Type of,filter materialJl�---_._ _Depthhofffilter r aterial 5� -----otalhlengthnch1_ --_F ----------`-_-_- Number of lines_______.. Jr_------" See Pit: Distance to nearestiwelL.____ll?O_/--_Distance fro foundation__.�!_Q__�---Distance to nearest lot line_ _____'-__. . Number of pits.----�----_:.---Lining material___-----Size:Diameter---_---. - --'-_=_-.Depth_._Zj~-------------'___--- Wt Cesspool: om nearest wel---- Distance from faundationt - ng material-------------------------------------- Size: -l-s- . ze: meter-: - ---- -Depth ----- -- - ---Liqu Capacity--------------- -------- ❑ iflm�wOi. 1 :et Privy-. Distance from nearest well-----------------------.--------------------- Distanceif�om.nei!� arest building------------------------------------ to nearest tat line..._____..__c ---------------------------------------------------------- Di Remodeling and/or repairing {doscribe}------------- ii`h '1l ---•--`------�- � � �=7F T I " ------r-------- ----------------------------- ------ f } _______ _____________ _ ____________________._________-________._.___ ____________________________1____ r u yy3 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State w and rules and regulations of the San Joaquin Local Health Districf. I y -- 4 d/or Contractor) (Signed)- -- " F r ---------- 1 -- ---- ------ = --=-_---•-=-------- -(Tit -------------- ---- -------- - - - .- ---- t le] (Plot pian, showing size of lot, location of,system in relation to Ips;buildings, etc.,.cantbe placed on reverse side). } FOR DEPARTMENT USE ONLY r "6 APPLICATION ACCEPTED BY _ ------------------------------------ DATI=--- - -------------------------------- REVIEWEDBY-- ---------- ---------------------- ------------------------- - T DATE BUILDING PERMIT ISSUED------------------------ a a- --------------------'--------;-------- ------ ATE-!'- m _ :... Alterations and/or recommendations---------------------- ------------------------ --------------------- ----------- ------------------------ -------- ------------------------------------ ------------------------- --------------------•------ ---- ------------------- - ----'. --------'--�-•-------------•- °-------------------- ----- - Date----- '---r--3---- ..---'--'---'--- ----------------- - -----FINAL INSPECTION �--------------------- ----'-' ! SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton 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•GD.