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F R OFFICE USE: .' --------- ------------------------------- --------------- APPLICATION FOR SANITATION PERMIT Permit No. ._ �J..34 `-- --- -- (Complete in Duplicate) Date Issued -_- ____ _________ _________ __________ This Permit Expires 1 Year From Date Issued 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. JOBADDRESS AN_D LOC ON---- /-------- ------------------------------------------------------------------------------ _43 --------------------------------- '� � ��.-Owner's Name--{Y- _ •�------- --------------------------------------------------------------- -------- Phone - --- -------------------------------------------------------------------------------------------------------------------------------------- Address-__'Contractor's Name------------ ----------------------------------------------------------------------- /544" � 0`7 ------------- ----- --------------. Phone---------------�- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 'Other ❑ Number of living units: /___ Number of bedrooms _f72_ Number of baths _ __ Lot size �14,0__'__-._-___--___.__ Water Supply: Public system % Community,system ❑ Private ❑ Depth to Water Table 'l�__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam F] Clay Loam El Clay N• Adobeg Hardpan E] Y Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �• c Tank: Distance from nearest well_________________Distance from foundation--- _--------------Material-____.-________-__-_______________._____.____. No. of compartments-------------------- ----Size----_------------------------Liquid depth---- ------ ---------- ---Capacity..._.__-------------•-- s field: Distance from nearest well_________________Distance from foundation.-------------------Distance to nearest lot line___________.__..- uJ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- fi- Type of Cter material----•--------------------Depth of filter material-----------------------Total length--_-----------------------------------_--- r , .it: Distance to nearest ----Distancejjom foundation-/4_---.___.Distance to nearest lot iine/4___._._ Number of pits---- _--------------Lining materialjr __.Size: Diameter___. Ja�'1 _'depth_... ---_______________ Cesspool: Distance from nearest well_________________`Distance from foundation--------------------Lining material-_______.-_-__._____._______-_-____.-. E [❑ Size: Diameter------------------------=-------------Depth-- `=-=-----_------------------------------------Liquid Capacity-- -----------------------.gals. � Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____.________________________.___._____- V? ElDistanceto nearest lot line---------------------'------------------------------------------------------------------------------------------------------------------------+ 'd ZWRemodeling and/or repairing (describe);__..---- u-- - - ------- -- ------------- --- ----- --- --------.._-__------------_ h.Q w,,dhr --------I -- - ------------------- `-C�-- 'v` h�L�. U - --------------- -------•----------------------'--- - -I---- ---------- ------r------�F --- --------------- ---------------------------------------------- --- -------- - -- -- - -- ---------------------------------------------------------------------- --------------------------------------------------------- -- = I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e laws, and rules and regulations of the San Joaquin Local Health District. -----____ _ '--- -------- - -- --- ----r�---- (Owner and/or Contractor) By:------------- 1 1� . --- :. {Title) .._._.:------------------------------- --------- (Plot plan, showing size of lot; location of system in rell�iio to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY---------------------- . -----•------- ----------------------- L�i DATE 2_r _ REVIEWEDBY------------------------ -------------------------`------------ ------------------------------------------ --------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------"` -------------------------- . =--:__._::-=__------------------ ------------------------ DA-TE----------------------------- Alterations and/or recommendations:-------- �__5' ----------- ______�------- ` -rti._-_t -_1`________ f / --L�y�Y ------------ � r—.^... _ � -------------------------------------- !1.._. FINAL INSPECTION BY:---- ./\ _` ------ Date--------- / ? y------- JOAQUIN,LOCAL HEALTH DISTRICT 1601 E.Hasoltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9thStreeta Stockton,California Lad!,California Manteca,California Tracy,California ES 9 REVlSED B-59 31A 3-'63 r-.P.CC. ,