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O OFFICE USE: -------------------------------------_------------------- " APPLICATION FOR SANITATION PERMIT Permit No. .___`_. _ ,_ .3 ' -------- -------------------------------------- ----- _c {Complete in Duplicate} _ � --------------: This Permit Ex ires ] Year From Date Issued Da+e Issued.- ��"r_IO_y t Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein describe . This application is made in compliance with County Ordinance No. 549. , =- [G' .Sim-t�-w-r+i�✓!�}��- !�_� r ; -�'.�`% - JOB AQQRESS AND LOCATION ►G-- ------------ -- ' L. Owners Name-------?�"e -- ------ ! Phone T ---------- Address = / //f� -------- ----- ------f, � � •� !i�tY I . € -- ------------------------------------------------------------- Contractor's ----------------------•---- Contractor's Name--------- -- f -- ---------------�------•------------ Phone t Ins+allation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ' Number of living units: __./_ Number of bedrooms �?. Number of baths._ Lot size Water Supply: Public system ❑ Community system ❑ Private Depth.to Water Table/s_,ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ San ay Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Ilf yes,date--------------------lI No ❑ New Construction: Yes ❑ No)< FHA/VA: Yes ❑ No ❑ TYPE`OF INSTALLATION AND SPECIFICATIONS:. (No septic tank or cesspool permitted if public sewer is available within 200 feet. #pl*cank: Distance from nearest well___-__.. - _°Distance from foundation_____________f_____.Material__-___-.#__--_-_____-_-_.-________--_______-,. No. of compartments ': `(Size------------------= -------Liquid depth---------- Capacity--------- Id: Distance from nearest well-11-d—L Distance,from..foundat.ion. ..� Dis+once to nearest lot Number of lines-_-_ ,�__-�__ - _•_Length -of each line_ 4,0--�____ _____.Width of trench- - _________" Type.of filter mat lal�,�i- ___Depth of filter material___- g ___-_-_Total', length_r_-___.__"______� D_ ------- Seepage Pit: Distance to.neares# well------------ k -----Distance from fo nu detion___..-------t____.Disfiance to nearest lot line----------------- 0 ❑ Number of pits---:J---------------Lining.imaterial___--- ------- ------Size: Diameter.'--------------------.Depth------------------------- Cesspool: Distance from nearest well--------------:---Distance from foundation...................Lining material------------------------------------- '1 ❑ _... Size: Diameter 3 -------- -- " -Depth---------------------- `------------------------P l--I-- ---- ----Liquid- Capacity--------- ---=---- ---------------g---a-----l-s-- ---gals. f Privy: T Distance from nearest.well---__ --------------------- --- ---____Distanes fromnearest i�uilding _.-.-_______,____.:______ " ❑ - s -- Distanc•�e t�o nearest lot line.--_-,: - `--:----- ------ __--------_•---------__------ .w .: _ 9 U,_Remodeling and/or repairing (describe)__________________ 4 -------------------- -----------________ - 6 ! - i --- --------------•--••----------------------------------------------- - - -------------•----- ---------._...------ __-_._ ----------------------------------------------------_____._____--______________-.._________ _________._._________._.___.______-__.- f.__________ ____-*______'_-___________.____.----------------------------- . i - - --- 111777 I hereby certify that I have prepared this application and that the work will be done:'-in accordance with San Joaquin County ordinances, St laws, and rules and regulations of the San Joaquin Local-Health District. (Signed) P/- --- .(Owner and/or Contractor) --- - - ----------- By=-------•----------- -- ------- - ----- ----Title__. - (Plot plan, showing size of lot, location of em'in relation.to wells, buildings, etc., can be,placed on reverse side).- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- -------------------------------------- DATE------ --------------------- REVIEWED BY ------------------------ ----------------------` ------------------- DATE---:---•----------------------' BUILDING PERMIT ISSUED---------------------------------------------------------- -p __ DATE-=---- •----------- ---••----------------------------- Alterations and/or and or ecom---e dation ------ - ---------- -----------�----- --- -------------------------------�------•----------- .. ,f 1if 7- ----------------------- .-------------------------------------------------------------------------------------------------------------------- --------------------------------------------...-------------------'------------------ •----------------------------- ------------------------------------------------------------- --_---__----------------------------------------•-------_ - FINAL INSPECTION BY....------C.:.. 2.� - -------------------------------- Date------ ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California (racy,California ES 9 REVISED EI-SID 3M 3-'63 F.P.OD.