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�s,rrriC.t USE: —�--�-•--- - I�-4--- / + . - ----7-------------- / --------------- ----- ----------------------------------- I APPLICATION FOR SANITATION PERMIT Permit No. ..l--7---3--- 9 (Complete in Duplicate) / This Permit Ex ires 1 Year From Date Issued I �P --------------- ------ --Date issued /6 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein dese",bed. This application is made in compliance with County Ordinance o. 549, JOB ADDRESS AND LOC ION.-.- Owner's Name------- _ . ----------------------- ----------- Phane---------------------• -- Address-------- I - - Contractor's Name_____.___ -'- --------------------------------------------------- - • -----•--- - ------------------------ Phone Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of.living units: ---/_ Number of bedrooms Number of baths __/_ Lot size F]---- -" Water Supply: Public system CommunitY" system ❑ Private ❑ Depth to Water Table�.dr ft. Character of soil to a depth of 3 feet: Sand ❑ .Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe &--Kardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No 91—.FHA/VA: Yes ❑ No ❑�, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r tic Tanbl ance from .��J�/ Not of compartments{--We,i__---____-""._ _ Size from foundati�in uid�de th. Material----------------------------------- --.-- ---- -.. �i _ q p� --------------Capacity-----------"----- ----- Disposal Field: Distance from nearest wEff --_- Distance from foundation_.. ' ' .� Distance to nearest lot line--" _,"_... G Number of f roes__�__:""l_"-- "--"__-_ " ""Length of each line-___!;" ? _ ----_Width of french--A (A (J - Type of filter ma.terial_, gG�_ Depth of filter material_-- �---__---Total length---- Pit: Distance to nearest well.__--'------ ___Distance from fnu�rdation-"�Q� - ____.-____ Disfg�e to nearest lot fine-/1--_ ®� Number of pi#s__:. --- ------- material_-" -----.Size: Dia meter- --------Deptha?.e--,r , Cesspool: Distance from newest well-----------------Distance from foundafion_______________ Lining material ---------- ❑ Size: Diameter--------- ----------- ---------------Depth ------------ ------------- ---- ----- - --------- -------gals. Liquid Capacity- ---- ----------- - S Privy: Distance from nearest wel!_____..______'--"___________________________ Distance from nearest building Distance to nearest lot line__________________" - --------------------------"------ ---"----------------------------------- --------------------------- Remodeling and/or repairing (describe):------ W11 , ( �� ----------- ------------ ---- ---- y ----- -! _' ----_ ___Z ----- _-----.------------------------"---------------- ----- -- . ----- I Hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la d rules and're lations of the San Joaquin Local Health District. (Signed)- _ ---- (OWr -- By---------------------------------------- i (Title}----- " " wrier and/or Contractor) ---•-----•- - ---- ------ ---- P of plan, showing size of lot, location`of sy in refs#ion to wells, buildings, etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-:--.-C---t-- A --------------- DATE-----'I ' 4------------------------ REVIEWED BY " ----- --•-- = - -------------- ----------------------------------------------- --•--- DATE------------------------------------------------------------- ----------------------------------------------PERMIT iSSUED ------------------------------------------------------ ` - Alterations and/or recommendationsc---,�-'e__.-E�- -- I f j _ i A' --------------------- -------------- si. ------------ ----------------- r v .. FINAL INSPECTION BY:---__.C_�.- s----_- - Date 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. "300 West Oak Street 124 Sycamore Street Stockton,California fedi, California Manteca,California 205 West 9th Street Tracy,California ES 9 REVISED 8-59 3M 3-'63 F,F.0 D.