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FOR OFFICE USE: ------------------ -------------------------------------- ------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -1k42------- ------------------------------------- --- ---------- T ' " — (Complete in-Duplicate) Date Issued ---/a- 3 ------------------------------------------ This Permit Expires 1 Year From Date Issued —Ctev —O Application is hereby made to the San Joaquin Local Health District for 'a permit to construct and-3(install the workro here' de rib d.. This application is made in compliance with County Ordinance No. 549. IM - --compliance -tc 5Z---- ---------------------------------- ------ JOB ADDRESS AND CATION--- ---------- S ---------- --------------------------------------------------------- Owner's Name. 0,'0" . ......... . -—---------------------7--------------------. Phone.. ------------_400"&I Address............... Corif ractor"s Name-------------- - --------- Phone....- ----------------------- ------ ---------------------------- ------------------------------- Installation will serve: Residence' Apartment House C] Commercial El Trailer Court E] Motel L] Other E] Number of living units: ----Z Number of bedrooms _.umber of baths Lot size ------------ ----- --------------------- ------------- Water Supply. Public systemi E] iCommunity system E] Private PC Depth to Wate'r Table owt. Charictdof soil to a'deP�W' of.4 fe'64: Sand [] Gravel 0 Sandy Loam E] Clay Loam D< Clay El Adobe E] Hardpan C] r Previous Application Made: [If yes,date._.._____:,_.....-#aCo NoAZ New nstruction: Yes FHA/VA: Yes D NoNo _1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we1l__,X71:P__�Distance from foundation------/iP.___Maferial No. of compartmil-,f------------ /8 --- ---------- --------------------- __2_/__d_ Lquid cle��h------- -Y_ __6� 11 - ------------Capacity.......X------ Disposal Field: Distance from nearest Distanc'e from f6undation-------7�_ _-------Distance to nearest lot line---.__._...`J_ %J_�' Ir Number of lines-.'-------------2-1------------Length of each line-------- e--- ----Width of trench-------------A---- - -----------;-------- Type of fiiter Depth of.filter material.--_ -oZ_ _Total length-----------------,'0 ------------ Seepage Pit: Distance to nearest well --------------------Distance from foundation--------------------Distance to nearest lot line.....--..-_.__._. ------------------- --- -- El Number of-pits----------------------Lining material--------------- Size: Diameter.- Depth ------------------------ -- Cesspool: Distance from nearest well-----------------Distance from foundation._.------------- Lining maferial--A.---------------------- f ------------ ❑ Size. Diameter------- ------------------------------Depth-------------------------------------------:....... ..Liquid Capacity-.---------------------------gals.ri7qto Privy Difance from neare.5f,wO----------------------------------------------- ---Distance from nearest building............................ ❑, Distance to nearest lot line--. ------ ---------------------------------- - Remodeling ---- ---- ------------- ----- ------- -------- ------------------------ -r-- --------------- -- --- ---- ---- - ------------- -- - ----------- --------- -- v- ------ - --------------------------------------------- - ----- ------------------------------------ -- ------------------------- ------------------------ ------------------------------------------------------------ ------------------------ I hereby certify that ("have-prepared this application and that the work will be done in accordance with San Joaquin.CoLinty ordinances. State laws, and rules anregulations of the San Joaquin Local Health District. 1A (Signed) • - ------- - - -- --------L-----------------------------------------------------------------(Owner and/or Contractor) By: ......... ----------------------------------------------------=------------------17-- ------(Title)--------- - --------------------------- --------------------- (Plot plan, showirig'-tize,of lot, location of.system in relation to wells,,buildings. efc....caLn :placed on reverse side). FOR D&RTMENT USE ONLY" APPLICATION ACCEPTED BY--- ` ..._. - DATE.. l� / G REVIEWED Y---- REVIEWEDBY---------------------------------------------------------------------7-------------------------------------------------------- DATE BUILDING PERMIT" ISSUED--------------------------- -------- DATE 0 -YO" ____ - -- ---- ----- - --------- ----------- ----- ------ commend tions:__ ----------- - ;;omm d f' ;.' Alterations and/or re --- ---------- - -- ---- -- ---- -�e ---- ------- ---- --- - ------- --------- .. ... -------- --- -- ---- .... ----—--- --------------------------- -- - - -------- --- -------------- - ------------- ---- ----------- . .......... ------------------------------------------- 07 -------- ----------- ---------- ----------------- -------- ------------------- ------------�------- ---------------------------- ----------------------------- -- ------------------------------------- --------------------------------------------- ----------------- ---------------------------------- --------- ----------------- ------------------------------------------------------ ------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:-----------------------------------------;----------------------- Date--------=------------------- SAN ate------------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 4, Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3`63 F.P.00.