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FOR OFFICE USE: --------------------------------------------------------- .._._.._._.____________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------- ------------------ p e) Date Issued __�l -------------- ------ --------------------------------------- (Complete In Duplicate)Date Issued ; ---.-.- This Permit Expires 1 Year From 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 made in compliance Ith o ty Ordinance No. 003—to — s t ,yy�� t--- JOB ADDRESS LO TION-- -��---�'�-t---�-�--- -- - - -- -=---amu - ---• •- •---- t4 Owner's N , Address------- --- -----�-- - - ----��--� -----...----- . _. , Contractors Name----- ---- --------- •------ Phone--------------------------------- Installation --------------- -Installation will serve: . Residence Apartment House ❑�/Commercial E] Trailer Court ❑ Motel ❑ Other E]Number of living units: I---- Number of bedrooms ___'rte_`_ Number f baths ;;----,Lot size __________________________ Water Supply: Public system E] Community system El/Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: -Sand.❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: [if yes,date------__.-j-�_..___} No ❑ _New Construction:.,Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ .� TYPE OF INSTALLATION AND SPECIFICATIONS'4--{ t V /(Neffe tank or cesspool permitted if public sewer is available within 200 feet.)SepDistance from nearest well -_�4___--Disfa ce from fo�un�}on.__/(,?__�_____Ma �ial____LA_Kt��FC No. of compartments_:___ :__ w- - Size ,_/ q p _ - - �L /�-�--�-----Li uid de th----- ---- ----------CapacitY--��d C1 Dispos Field: Distance from nearest well--- C)___._.Distance from foundation__.L 0_ ___-Distance to nearest lot line._s.45_---------- C Number of iines___.'�___cz;?__ Length of each line________ _ .(----__.___.Width of french_____2_�__ Type of.filter materiali-__ fwDepth_of filter. material_...__/__Y_A-----Total length-----1�-941 ____________________ See a Pit: Distance to nearest II_____ ___aa------Distance fr m ndation__ r p �49______-__-Distan re to nearest lot line.a�-_-._.__ fl 1 Number of its__.._ ___ Linin mater.ial�--- 2-_ -__-, p I .S A g t Size: Diameter _ De tn--,�------------------------- Cesspool: Distance from nearest well-----------------Di;tante from foundation---------------------Lining material---._------------.__._________-__-_.. ❑ Size: Diameter------------------------ pth =_ F Liquid Capacity gals. . Privy: Distance from nearest well f_____________ ---------------------------------Distance from nearest building--------------------- ___________.._____-. ❑ Distance to nearest lot line - - --------------------------------------- --------------------- -------------------------------------------------------- -------- Remodelingand/or repairing (describe):----------- -------------------- --------••--------- ------------------------------------I-------------------------------------------------------- ----------------------------------------------------------------------*------------------------------------------------------------------------------------------------------------------------------------------------ -------- ------------------------------------------------------------------------------------------------------------------------ -------------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, a s and regulations of the San Joaquin Local Health District. (Signed) =- ---- ------ ----- -- a� ;e -------------------------- --------��µ�ilt�6R�d•/or Contractorl cO -- � --- --- ------ - �/n - -----------------------------------------(Title)- - -------------------------- ------ --- ----- :_`_ - -(Plot plan, s owing size of lot, locati n in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY j ----------------------------------------------- DATE-- '/_v- 4/f REVIEWED BY ----------------------------------------------------------- DATE---- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE. Alterations and/or recommendations:------- - ------------ - --------------- ---------------------------------------------------------------•----------------------------------------------- A ------------------•--------------------------------•--------••-----•---------- -- ------------------------------------------------------------------------------------------------------------------------------------------ --------------------- --------------------------------------- ------------------------------------------ ------------------------------------------------------------------------------------------------------- --------- ------------------------ ------------- -- ---------------------------------------------------------•-------------------- ------------------------------------------------------------------------------ ------------------ F€NAL INSPECTION BY - Date �3 -I4 -6 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naxelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED B-59 3M 3-•63 F.Y.CD.