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FOR`CrIIFICE USE: to _ APPLICATION FOR SANITATION PERMIT Permit No. .. ----- --- ---------------------------------------- (Complete in Duplicate) Date Issued '.,'/ (13 - ---------------------------------------- ------------- ______ ----..---.-._ This Permit Expires 1 Year From-Date Issued -_ ._�_ ______I� 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 with'County Ordinance'No"549-- r 2_.;�(P S S - -'f 4--JT7r E -/ JOB ADDRESS AND LOCATION__ 'd c to .-------------------- - - ------------------------ Owner's Name ` f �--- -I-t`.!•� --- Phone--._---- ... Address-•....................... ,� --. �--"' -•----. :.:_ -------------•-�---••-•----......------------------------------------- - ------------ I -�=�'�-�� Fn� ��-------------- 3 � ..� Contractor's Name--------------------------------- -- --- Phone---••-- Installa+ion will serve: Residence ❑ Apartment House ❑ Commercial X Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size _----------------.:_---.-_ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table -------- ft. t Character of soil to a depth of 3 feet: Sand ❑ Gr,�i I ❑ Sa ldy Loam [b<Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Applica+ion Made: (If yes,date.__°__ ---------1 No ❑ New'Cons# ctian: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE-OF INSTALLATION AND SPECIFICATIONS: ` � Se tic (a�nk: P Distance from Dearest well___ ._..�_ _Disfi nce Mable within 200 feet.) No septic tank or cesspool permitted if public sewer is ava - - from fa ndatio---.- _Pr P 1 ---------Material 'tel `� N No. of compartments..........��------Size�k-16_X_ --:_-_Liquid depth---------- -------------Capacity-_- �'��Q f , Disposal Field: Distance from nearest well-s 0_---Distance from four ation---_---C-- y Dista ace to nearest lot line`___ Number of fines------------- --- g rT� i Length of each 1i - idh of trench___.___ '___._ _ Total length fv _ t --------- Seepage Pit: Distance Type oftloenear striwell._._---��D scan oth f from rfoundation-------.!` ,_._ 0ista ce to nearest lot line----------------- ' ❑ Number of pits----------------------Lining mater':al.---------------------:Size: Diameter__ �_-�� - -------t6epth---------_----------------------- Cesspool Distance from nearest well-----------------Distance from foundation--------- lLI 19 material- � Depth 1 iquiYj Capecit�------------------------ g i Size: Diameter--------------------- p --_- -_- gals. Privy from nearest well_________________________________________________Distance from nearesthuildin�g___;___._._.._______________._____.____. I Distance to nearest lot line s ----------------------------------- - Remodeling and/or repairing-(describe):....---/- .�.�.-.��-lt----_--- �� + � -~ ---------------------------------------- ---- ------------- -------- ------- ---------------- ------- �11a, + e ----------,- - .� ---- -•- --------------------------------- ------ iL I hereby certify fh I have prepared +his application and that the work will be done in accord alice',wifh Sari Joaquin County j ordinance`s, SS ate laws,,and r:levand-regulat' s,ofrthe,San-Joaquin•Local Health�6isfrict. (Si ned . 'r° ` 9 )- ---------- ---•-A---.;�--- -- --- - -_ -w:-. -------- --------.--- -:-:-___._-l�^I�t'�t,._#fit-"�----�� ------------- ----------(Owner and/or Contractor] B ' - It---------------------- -- ------------ Tl+le (Plot plan sl'iowing size of lotIlocation of system in relation to wells, buildings, etc., can be placed on reverse side). lFOR-DEPARTMENT-USE-ONLY--- L - APPLICATION ACCEPTED BY-------- ---- --------- , —------------------------------------------------ DATE------------ - 1 REVIEWED BY----------------------------------I--------- ----- --------- '-------------------- ---------------------------------------- DATE------- - -------------------------------- BUILDING PERMIT ISSUED-------- ------- ------------------ " ."-------------------------------------------------- DATE:--------------------•--------- - Alterations and/or recommendations:.----___-- e _ - �_ ------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ - ----- ------- -- --r-- - -----------------------------------------------------•---------------------------------------------------------- ------------ ------ ---------- ---------- -------------------- -- - -- --�---,-------------------------------------------------------------- -------------------- FINAL INSP - - _ // Date-------f .1._ rQ ------------- SAN JOAQUIN,OC L HEALTH DISTRICT. 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Ma,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F.P.CO. -