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" FOR OFFICE USE: ------ ---- ------- ----------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....e 7 � .... -------------------- -----------------------=------- ----- (Complete in Duplicate). Date Issued = _ ------------ j This Permit.Expires 1 Year From Date:Issued_ ,..�....,:.r ��e.�.. ... 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 ma -de:in-compliance_with County Ordinance No. 549. r 0r _;-`070 - 37 JOB ADDRESS AN OCATION__-1 . - �-s�.i---- - °- ------ ---- ..__ . - . .....r. h ------------------------------ - � ��' - .. Pone Owner's Name---------- ---air-- - ----- ---- �- -- I __-- i:, Address. -' == - "- --- -------------------------- ------------- ----- Contractor's Name--- --- � F f - ---------•--- Phone....--•-•......-----------------.. :. Installation will serve: ..Residence Apartment use ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /---- 1- _ Number of bedrooms _ Number of baths __ _____ Lot size -----------________ t Water .Supply: Public:system ❑ Community system ❑ Private+Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ I Previous Application Made: {lf yes,date----------- No ElNew Construction: Yes E] No ❑ . FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) y J` Septic ank: Distance from nearest well--- Distance Distance f`om fo unda`ion------- __.Material -- __________. ------- Liquid depth---- Capacity - No. of compartments_.__Z____ _Size_ ___ _____-_._Ca acct ,/,5'474�X_- P Dispos fold: Distance from nearest well___4---A-Distance from foundation----/.Q_ __._.Distance to nearest lot line�_�_-._..._ Number of lines-----------�.-- ---- -----._Length of each line------l0P0---i--------Width of trench-.----- �------ -------•_-- �r Type of,filter material__�,�--------Depth of filter material_._.__/�_____._--Notal length_______ d 1 } Seepag it: Distance to nearest well-----/ P________Distance from foundation___ s� ---" �3 e Deptest lot l��'�---'---.� 1� Distance to nearest lot Im � ,.� 1; Number of pits.__.--__+� --_Lining material-.��__._��..---Size: Diameter_______ Distance from nearest well-------------- ------DDiistahco from foundation:_:- --------------_ Liquid Capacity_._____-- _.._____________gals-------------- Cesspool: ❑ e Size. Diameter p Privy: Distance from nearest well------------------------------------------------Distance from nearest building__,---------------------------- ---. x iiiddd a .< � Distance to nearest lot line ---- - ------� --------------- ------------------ -------------------- ----------------- ---- ----------------- ---------------- �.❑ Remodeling and/or repairing (describe):---------,---------- ------------ ----*-°----------- --------------------- -------------••-------•- ------------------- :., t ------------------- I herFcertif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancews, and rules andre _tions of the San Joaquin Local Health District. d/or Contractor) (Signed) n ------ - -------------1- -- ,By _ __ -------------------------------1F, , �-t.{Title) -- -- - -- (Plo# planize of lot, location of system in rela n to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- - ------------------------------------------ DATE- --------- - -------------------------------- -- REVIEWEDBY------------------------------------- --- --------------------------- DATE-------------------------------- --------------------------- BUILDINGPERMIT ISSUED------------------- --------------------------=-----------------------------=------------------------- DATE------ ------------------------------------------------------ ` Alterations and/or recommendations:--- ----- - ---------- ----------•------------------------------•------------------••--•-- ------------------ ---------------- ------------------------------------•------------------------------------------------------------------------------------------- ----------------------------------- /� Date---f---r--------------- ------------- ------------------------------- FINAL INSPECTION $Y:../, � �' f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocktonr California Locil,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 C.P•Da. I