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FOR OFFICE USE: 1 ------------------------- ------------------------------ / 7 / ______ _________ ________________ APPLICATION_FOR SANITATION PERMIT Permit No. .-_._..... _.._...... - --------------- -------- -------------- --------------- (Complete in Duplicate) Date Issued --- r'Y-7 � - -------------------------------------------------------- This Permit Expires 1 Year From Date Issuedr 14,0-0-9, Application is hereby made to the San Joaquin Local Health District for a permit to construct and Install the woriherein described. This application is made-in.compliance with County Ordinance No 49. X.4-1- - C _ E Lt vim,.oA-rr.�D. .. _ � 9/ ------------------ ----- � -B ADDRESS AND LOCATION----- ' �y---�----- ---"= --------------- -- O Hers ame f l + L Phone ! I -19T' Address � r ---------- - --------------------------------- --- Contractor's ame._ `s � = -, gyp' Phone_- ... n . Installation will serve: Residence Apartment+House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __. -- Number of bedroom._ Number of baths -------- Lot size _, i ____ :------------------------ Water Supply: Public system ❑ Community system ❑ Private epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam, ay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----.--------------) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Ta� Distance from nearest well-------------- Distance-from foundation--------._ -T _ Material---__---_------ _-.--_�------------- _�_. No. of compartments Size Liquid deI------------------------- Capacity f��;,— osal Id,�p Distance from nearest well...f-ifti"_._Distance from foundation---- --- ---------Distance to nearest lot line__--__---_-.----- l Number of lines_____ ______ __� }}-Length of each line__---l�-_C_s f__ .Width of trench__c___y!t---------------- Type ----..---------�_ r T e of filter material; �+i�4_-De th of filter material----__-/� Total length------------------------ -0-_--_ yp p S age Pit: Distance to nearest well---------------,_Distance from foundation--------------------Distance to nearest lot line-----.--_-._----- N t Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- O Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------.-__._____------- ❑ Size: Diameter-------- ---------- ----------------Depth----•----------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well __________--------___---------------------------Distance from nearest building------------------------------------------- 0 Distance to nearest lot line--- ------------------------------------------ ---------------------------------------------------------------------------------------------- b' Remodeling and/or repairing (descriL,e): - I - --- - -- ----------------- ---•--------•-------------------------------------------------------------• --------- .. ---------------------------------------------------------------- ------------------------------------------------------ ----- ------------------------- - ----------------- a =-i ------ - --- --------------- I hereby cert' tat I ave pre ared this application and that t1 work will be done in accordance with San Joaquin County .: ordinances, Ir ws, d rules an gulatio o the Jaa uin L ealth District. (Signed)---- -- -�------- ---- �— -- ------ - -----------_(-t-------- ----- ----- - - �------------------(6� -Contractor By:---------------------------------------•---------------------------------------------- ---- ��-- ---------- ----------- Title --- 1� (Plot-plan, showing..size of lot, location.of.system.in relation wells, buildings, tc., can be placed on reverse side).; -� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------rv5.--- �� DATE--------- /� 7 I �----------------- - ---- ------------------------------------- REVIEWED BY------------------------- ------ - - --- ------------------------------------------ DATE-------------- ----------- ----------------- -- ------------- - BUILDINGPERMIT ISSUED--•-••----------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:------- -- ------- -- - -------------------- -----------------------------------------------------•--•----------•------------------- ------------ ------ •--------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------------------------------------------------------- ------------ - ------------------------------------------------- ----------------------------------------- -------------------- - -- ---------- ---------------------------------- I-------------- ''-------- -•- -------- ---- ------------------------- FINAL INSPECTION BY---------------------------- ------------ Date........................ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 3M 3-'63 F.P.CO. ti.�4