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`.a FOR OFFICE USE: 3-ic __ _____ ________ ____________ .'',' -__.- APPLICATION FOR SANITATION PERMIT Permit No./6___7 _ --------------- (Complete in Duplicate) Date Issued Z. p� -------- This Permit Expires 1 Year From Date Issued > i jr--o-7o.-©/ 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. . JOB DDR SS AJL LO TION_ --�.- 1_ �5, w -. Owner's me ----- ---•-- --------------- --- - ----- ---------------- ----- --------------------------------- Phoq ---- � Address - ---- ----- 4J ----------- -- - - - ------- 1- � ------ ---------- ---- --- - Contractor's Name_ :: -- C1[� ' - L'- �'``•v-r ..... --------- Phone. Installation will serve: Residence Apartment House ❑ ommercial ❑ Trailer Court ❑ Motel ❑ Other Number of living.units ____ Number of bedrooms 4-_.- Number of the-3__ Lot size _. __ �___ - . Water Supply: Public system ❑ Community system El Private Depth.to Water Table-(C//JQft. _ o Character of soil to a dep+h of 3 fee+: .Sand ❑ Gravel ❑ Sandy Loam ❑ . Clay Loam [❑ Clay ❑ dobe eHardpan ❑ Previous Application Made: (if yes,date---------------------l 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.) tic Distance from nearest well_________________Distance from foundation--------------------Material--------------------------------------------------- No. of compartments_.--------------- Size----_---------------- Liquid dept----------------------------Capacity------------------- _ Di s o I Field: Distance from nearest well-5.0_.__-Distance from foundation____IjO___.---Distance to nearest lot k f line--/-A&- 17 _ ______ Length of each __._ __.Wid#h of trench- r � _---' _- _ Number of lines_ _e f .-...Type of-filter material _ .__. .- Depth of filter material---- length____�_4-Q-_-_____f------_- , • Seep a Pit: Distance to nearest wO_/—.___�_D-istance from oundation__ _ _____.Dit�ce to nearest lot line._____.... . Number.of-pits__._,'I__-.-------Linin g material-) -0 .....size; Diameter___-1!��L_.. ___f�_.---Dept h_____-.�j'.__-____ Cesspool: ,r '`ti Distance qlm nearest well------------------Distance from oundation___----___-_-------.Lining material----------------,_----------r-------- y� ❑ size: Diameter- =---- -------- -----Depth---- ----------------------------- -- -- --_-Liquid Capacity ------gals. . • Privy: ;` Distance f om newest well_________.___________________________----------Distance from nearest building-r_ t -- ❑ s �-'Distance to nearest lot line-f------------- ------------- Tx Remodeling and/or repairing (describe]:- -------------------•----------- -- -----•-------f------- --------------------- - ------------------- J- ! r ;- - - 'te t . ----- --- --- - - ---------- ------------------------------------g- ------- - `N_ �1 it ' �-C� -----------------=--------------------------------------------- --- --� =`Thereby rti that aveprepar`ed +his apphca+ion that the wo will beVd.nncordance,with San Joaquin County ordinances,' to aws,ra ulesiand tions he Joa uin Lo Health *(Signed]-- ------ •--------{-----------r-4 - ---- --- --- �--- --{ e o t Contractor] -----------------•----- ---.-_ I By:_'� :_ % ,. ---- ----- {Ti#le] - - (Piot plan, 'howing size�f lot, locat-.on'af system in r +ion to.wells, build-. s,.etc., can be.placed on reverse side]. lj FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED;BY---- �4' -- "z � s DATE REVIEWEDBY -----------'==-- °-- -- -----------------------------------------------------•-------------------- DATE----------- ---------------------------- BUILDING --------------------------BUILDING PERMIT ISSUED------------ �.,..�:- = DATE .1 Alterations and/or recomm 'da ion -- ;^ - ( � r ---------------------------••------------------------------------------ 41--- 'x�---- f---- --�`4.. - --------- -- - =f- ,7�L4'.__r:�fv-- --- •------- ------ + 9- ' - r .'/• ' -- - -- -- --=- --- - ---.---- i =----------------s ---- ---- -- If. Fei ft r a ] J� � 4.. FINAL,INSPECTION BY------------------------ .----- - ------------------ -,Date-- ----------- ----------- -----•---------------------------------------------- -1—SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avi. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVlSEO 9-59 3M 3-'&3 F.p.CO.