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FOR OFFICE USE: q�, ---------------�,&6- --- ------------------------------- ----Z ------------------ ...... APPLICATION FOR SANITATION PERMIT Permit No. .....__........__...... --- --- ------------------------ ------------------ (Complefk,in Duplicate) -------------------------- -------------------- ./This Permit Ex'ires I Year From Date Issued Date Issued p 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 complian6e with County Ordinance No. 549. JOB ADDRESS AND LOCATC6N-----------3---5'...y2 • ----------------5--------------- ----------------- ........................ .......... Owner's Name-------------je A Of- - - ----- -------------------------------------------- Phone------------------------------------ Address........................ - ----------- Contractor's Name------------------------_-----5........... ----1_4 ......................................................................... Phone................................... Installation will serve: Iken partment House [11 Commercial El Trailer Court .[] Motel Cf Other 0 Number of living units. ,_,11N bar of bedrooms .)4�Number of baths ln�_ of size ........-------OF.. ...... --------------_-------- Water Supply: Public system D--Community system [I "Private �pth TO Water Table ft. *77 Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam [Clay Loam [3 Clay E] Adobe[3 Hardpan [I Previous Applic/,:tti Made: (If yes,date____________________) No New Construction: Yes El No Q—FHA/VA: Yes 13 NO 4;3- TYPE OF INSTA'i-LATION AND SPECIFICATIONS: (No septic tank or cesspo6l p6mitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----%)7_4k_Distance ifrom foundation.----1.-4-21-.-..Material--- ------ No. of comp;rtrAents.--.-------Z,--------Size-'Y---Z-=X _t`Liquid dep�k---------V-----------_Ca aci !F1 Disposal Field: Distance from nearest well---- Distbnce from foundation........2�ct....Distance to 'nearest lot line----_-_3.'t"�'s Number of lin'es---_--------L-----------------Length of each line-----------A::;;.-c...........Width of french---------_--7.7.. ............. Type of filter'rnaterial_ ___Depth of filter material____,--K.........Total length___________- -------------- Seepage Pit: Distance to n"rest well........ ---Distance fr6m foundation----/..%,av-.Distance to nearest lot line..... Number of pits--!---- Lining material--- LSize: Diameter__,99.e_,4.�r/_Q Depth_________________________________ Cesspool: epth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material._._____.___________.____________❑ Size: Diameter--"I -------------Depth---I------- ----------------------------------------Liquid Capacity----------------_----------gals. P_ I :.I Privy: Distance fromk6earest well---------------------------------------- --------Distance from nearest building------------------------------------------ 0 Distance to nearest lot line_________________ -------------------------------------------------------------------- Remodgling and/or repairingdescribe -------------------- � ------- ----------- ......................14...J00e - . _..=•:. 1 ------4.......... ----------------- ------ -------- -------------------------------------- ---------------------------------------------------------------- --------------- ---------------------------------------------------------------------------------------------------------------- ------------------------*----------------------------------------------------------------------------------------------------------------------------------I------------------------------------ I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County - --------- ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) --------------------- (Owner and/or Contractor) y__ --- -----------------I- ---------------------------------:-------------------------------------------(Tif 10)------------------------------------------------------------ -- --------------------------------------------------------------------------------------------- (Plot pla)showing size of lot, location' 6f system in relation to wells, buildings, e+c., can be placed on reverse side). -4 I %DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY----------- s ---IJ4._e---------------•-------•-----•-------------- DATE------ -- -f REVIEWEDBY---....---------_------------------ ..... ----------------------------------------------------- -------1....... DATE-------•----------------- BUILDING ATE--------------------------BUILDING PERMIT ISSUED--------------------------------------------------------r-------__--------------- --------------- DATE-----------------------------------------------------•------ Altera i ---------- Alt rai ns and/orreco ions:.____ --------- - --- ----------------------- 'r -1 , ---------- 4a— " - C; M 41-------------------------------------------------------- ---- ---- ------------------------------------------ -----------------PCLI-------------------------------------------------------- - --------- ----- ---------5:---- . ......... ------------------- L ........... .. ...................... ----_-_--- -------------------------------------- ................ -- ------------------ ------------------- ...... ------------------------------------------------------------------------- /3 INAL INSPECTION BY:....... ------- --ter -�'''--- ------- Date-------- --------------------- -------------------- SAN WAQUIN rO8AL HEALiH DISTRICT Al� Ar 130 South American Street 300 West Oak Sirsel 124 Sycamore Street - 205 Wits#9th Street Stockton,California Lo;ll,California Manteca,California Tracy,California ES 9 REVISED 5-59 2M 5-62 ATLAS + Ir-dL—?`7