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_ pjv/ j U I L/,6 FOR OFFICE USE: Permit No. ------- --------------" --------- APPLICATION FOR SANITATION PERMIT ----- ----------------------------------------- --------- [Complete in Duplicate) �1 ----- ----------------------- -- ------- ------ ---- -- Date Issued .�..�--•� 7 This Permit Ex fires 1 Year From Date Issue Application is hereby made to the San Joaquin,Local Health District for a permit to Construct ansl insta 1 the work h ein describe4. This application is i omglii}nc with Cou ty Ordinance No. 549. --------------- JOB ADDRESS AND LOCATION.----_ ------ ----- --- -------- f �Q Phone ` '1 ------�`' - Owner s Name----- -- "" _ ---•------------------------•--- -----••- -------------• --- •--•---- Address-p- 1 .r�� ! r------ ------------------------------------------ �� 7_� . �-G•-a ---------------------------------------------------- - --------•--------------•-- ----- Phone-:-- -- •-"-- Contractor's Name-------- Installation will serve: - Residence ❑ Apartment House X, Commercial ❑ Trailer Cour} ❑ Motel ❑ Other [INumber of living units: --2-- Number of bedrooms l�_ Number of baths -----r Lot size ."-_---- - �---•---------- I Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table 10 ft. F Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe[3 Hardpan ❑ date--- ) No L'1 New Construction: Yes No E] FHA/VA: Yes ❑ No Previous Application Made: (If yes �+ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ti Tank: Distance from nearest well_"-�~p__"-.-Distance from/found�rtion__.h -"-. -.Mat �a4 ------- -- ---�-------------------- j L�ll ------- -.Size__. 9_7-_,?l.�t-Liquid depth------ --------CapacityS._6Q,0-------- J No. of compartments_"."" -- A Disposal Field: Distance from nearest well_...5__0_'__"Distance from foundation-----/-Q_!- "Distance to nearest lot line_�� ---t -- Number of lines------------`�..---/�----- -------Length of each line---/--�---------�---- Width of trench.-------��s-,-�- ----------- Number ; � Type of filter materialc�_IGC� -Depth of filter material--.-- .----�-.Total length-- -----------'T -------- C2—) 0 SeXsspool: a Pit: Distance to nearest well----40-0--._-"_Distance from foundation--_.r d"_—.1-".Distance�to nearest lot line--_-4`---.--"- Number of pits-------�---------Lining material Size. Diameter._.---.- Depth----------.-% ----- . C Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 0 --.-------"--"--------------- - ----❑ Size: Diameter----- --------------- ----------------Depth--------------------------------------------------- Liquid Capacity -----9 Privy: Distance from nearest weil----------------------------------------------- -Distance from nearest building----------------------------------'C7, ; ❑ Distance to nearest lot line- --------------------------------------------------------- ---•---••-------------------------------------------------------- --- . `v 4 �* r �.. I Remodeling and/or or re ,irin i(describe): ---------- ------- r- " -t ---- ---- -- . _ _" " ` 4 . . - c. ------------------ ------- s ------- ------------------------------------------------------------------------------------------------------ k _.- --------------- --- -------------- ----------- - _ I hereby certify that I have prepared this'application and that the work will be done in accordance-with San Joaquin County r ordinances, State laws, acid-rules-and re ulations of the San Joaquin Local Health District. ..#.. --- ---------- ----`----------------------------- '__.-""- {Ow and/or Con#ractor� I (Signed)--- --- - - ------ ---- ------------- --- --- - - - -- "".:. --f- �-- -� �re.w� ------------------------------------- --- )---- {Plot plan, showing size of lot, location of systenf in relation to wells, buildings, etc., can a placed on everse side). —" - FOR DEPARTMENT USE ONLY L k --------------------------------- -------------- ' ------------------:DATE----�- -- -.G--.. ---- --------- APPLICATION ACCEPTED BY------- . - - - REVIEWED BY--------------------------------- -- t------ f --- ----------------------- •DATE---"---------------------------- ----- - }----------------------- ------ � DATE---- t-------------------------------------------- I BUILDING PERMIT 155UED____--."-_"----�------------------------ ---- Alterations and/or recommendations —•----- --------------- " -" ------=------------------------------------------ ------------- ---=-- ------"------?•----------- --------------------------------- -------•----------•----•-------------------------------- s t -------- --------•------------------- ------------------------- --------- __"-""-.._•-.------._" --------------•-...._--__.-..-.__.--._--..--.--------------------------------------------------------------- --_.---------"----------------.----- ---"---------.------...-""--""---------------- k_------..--_-_--._. '!- ------------------------------------------- FINAL INSPECTION BY�.�!4"-- ---= ---"- b ', - Date-- -G ------------------ --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California £S 9 REVISED B•59 3M 3-'63 F.F.CC.