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PR-OFFICE USE: T --------------- J 4_ �, ----- -' APPLICATION FOR SANITATION PERMIT Permit No. {t t6 = (Complete in Duplicate) yS—�� L� -------------- - - ----------- -- -- --------------- This Permit Expires"I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healfhbistrict.for a permit to.construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. .� ,� : 01 1 1 JOB ADDRESSI,AND LOCATION.27 3at ____--_4---AWIr--- �, w 4, q' ` t -------------------- - --------- Owner's Name _ f - ---- •--------------------------- --------------------------------------- -. ....... 1 Address------------------• ------- - - --• -- - ----- - -------------------�--------- � _ Contractor's Name ----- �,--------•---'--------------------- ------• -- 14 ---(CI .U.11.11---•-- Installation will serve: Residence'[ Apartment House ❑ Commercial`❑ Trailer Court ❑ Motel ❑ Other E]Number of livingunits: _ __-Number of bedrooms =__ Number of baths _'�-__ Lot size Water Supply: Public system ❑ .Community system ❑ Frivate'X Depth to Water Table _4�0 ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previqus Application Made: 'llf yes,dote--------------------J No New Construction: Yes ❑ No FNA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank Distance from nearest well_________________Distance fr"foundation__--___________._.Material---------------------------------------- No.-of -_-No..of compartments----- -------------= --Size- µ ---------------------------Liquid depth--------------------------Capacity--------------- ------ Dis osal Fiel : Distance from nearest well-.-150. --.Distance to nearest lot line___ P P -_____.Distance from foundation:___ Number of lines__._t----____-__ Lei thieof each line-_-,._____ 1 ------ - 9 �-�--- --- --.:Width of trench------ ---�,�-------------- Type --------•- � T e of filter material__-- �L__-.___De th of filter material________ _ ........Total len th_______________________ yP I p gg Seepage Pit: Distance to nearest ,well-_t_0Q.1---------Distance om fo+�ndation-___ � Distance to nearest lot Number of pits.- ----------Lining material"_ I _.Size: Diameter-------- Depth---------- ---------- i 'Cesspool: Ds lance from nearest well------------.....Distance from_foundation---------___________Lining,material _---_-________----------------------- Size: ____,___,t___.______.Size: Diameter---------------------- -----Depth-------- ------------------------- - - - - ----Liquid Capacity-t• - -------------------#----�gals. Privy: -Distance from nearest well------------------------------ -_-_....Distance x from nearest building__..-___._____:----_-___________s___.-_ ❑ Distance to nearest lot line-- --------- ° f x - m4 Remodeling and/or repairing (describL-J:_--._. _- t._ ____ � _. _ "-- _ ----- --------------------------- --- - t�---------------------------------------- ------------------------------------------------------------------ L•:: p ------ ------------ _ ----------------------------------------------------------1--- -- ------------ ---------------_ ----------------------- ---1-----_----- ----" - - ----- -- I'hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and'regulatlons of the San Joaquin Local Health District. (Sign 4d)----------1P ----------- u-'------------------ ---------------------- - --------------------__--�---------------------- Owner and/or Contactor) : '� ----• ------------•--------- --- ----- ....... ----- --- t BY: w r -fit --- --- {Title (Plot plan, showing size of.lot; location r0 syste in relation to wells,.buildings, etc., can be placed on reverse side)!. _ t r FOR DEPARTMENT USE ONLY � - i x APPL4ICATION ACCEPTED BY ---- -- ----------------------------------------- DATE---z �---=-----(0--� REVIEWED BY -------- ---------- -------------------------------------- ------------------------ ---.------------------------------------- - --- ----- ----._ DATE-------- --------------•------- BUILDING PERMIT ISSUED ----- ------------------ -----= •-;-----_----• �ATE----------------------------------- i Alterations and or recommendafion�n s'_ _ i-.Q-r-._(p-_ N--- ;--_meq51' 1 / - ( t� ---------�-s------ c ----------------------- -- -------------------------- --------------------------------------_------------------------------- ----------------- ----------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- -------------=------... FINAL INSPECTION BY: _ ---- ----------------------- ------------------------- SAN JOAQUIN LOCAL HEALTH'DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California r Lodi,California Manteca,California Tracy,California ES 9 REVISED B-S9 3M 3-'43 F,I.CC. 10, �• /�r/•��y�/jJ'JJ�/}