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FOR OFFICE USE: ------------ ---- --------------------- Permit No. ..!_. --------------- APPLICATION FOR SANITATION PERMIT - ----- �� - - ----------- ----------------------- ----------------- _ (Complete in Duplicate) Date Ensued "::_--_----:-f------� _______________ This Permit Expires j Year From date Issued d. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein dent{ibe This application is made in compliance with�Co t •- pce v0/`'4 „� �rQ ld'' !/ �`i f ' P_ / -------------------------------------------------- JOB ADDRESS AND LOCATION....'___ ___ Owner s Name--------- ---- --------PX� ------------------------------------------------- ............. ---------------------- - ---- Phone----------------------._...--------- Ad dress--•--------•------- l- ----------------- fPhone..---•--•-----•----•--------•----••- Contractors Name ---------•-----------------•--l]-- ------ ----------------------------------------------•-- Installation will serve:,: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number.of living unifs: I------ Number of bedrooms *�____ Number of baths _/___ Lot size ______ -$-- L Wafer Supply: Public:system ❑ Community system- [I Private 10 Depth to Water Table b._ ft. ant Character of soil-to a depth of 3 fee}: Sand ❑ Gravel F! Sandy Loam E] Clay Loam [IClaye Adobe 0 Hard No Eli Previous Application Made: (if yes,da te-__________________I No jr New Construction: Yes, No ElFHA/VA: Yes ❑ TYPE'OF INSTALLATION AND SPECIFICATIONS: {No septic tank`or cesspool iiinitted if public sewer is available within 200 feet.) =' �- t P P �a-r . Material --------------------•- Septic Tank: Distance from nearest well_. ------Dis#8ncq.fro foundation_____ __________ _. :Size. _/�^!' �' `S Liquid depth----- Capac,ty_� - No. of compartments.... -- Disposai Field: Distance f om nearest well.:�P--------Distance from foundation-__- 0 ------Distance to nearest I tline--S___ -------Length of each line--___,l�'a__---------Width of trench-�.�----.--------------------- =Z_Number of lines.__._d�r----------- ----- Type.of filter,materiae-A -Depth of filter material___Y_P--------------total length---�-_-----•------------ .......� Seepage.Pit: Distance to nearest well --- --Distance from . uhdatian__ .........Distance to nearest lot line___--____._ C _____________Lining material_ a3 De th_ G ° fGI Number of pits- F ___-------- Size: Diameter.-__, _ __ _. p ---- } 1 Cesspool: Distance from nearest well_____________ ___Distance from on. .._._____..Lmmg materia____:- ._ .-_..__.._____.______.._____ _. ❑ Size: Diameter-_`_ ---- --------------Depth---------------------------- Liquid Capacity gals. Priv Distance from nearesfi wO--------------------------------------------- -Distance from'nea es+.building_______----____-.----------------------- Y - ---------- �. ❑ Distance to nearest lot line------------------------------------ ----------------•-- ------------------------------------------------ ------------------------ ' - 1.. Remodeling and/or repairing (describe)------------------------------------- - ------------------------------------ ____________ _ _ i_____ ___________________________________________ ___ ________________ - ---------___------------- -----------.---------------------- r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County id regulations of the San Joaquin Local Health District. ordinances. State laws, and rules a I (Owner and/or Contractor) ., _ . _ (Signed)__-.- -- -� - - - .. WTI (Plot plan. showing size of lot, locat on of system in relation fo wells, buildings, etc., can be placed on reverse side). 4 : #- t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. ----------------------`--------�--- DATE----= --�----- ------j -- DATE--------•---------------------------------- IREVIEWED BY------------------------------------------ -- BUILDING PERMIT ISSUED----------- --------------------- ------a-----=------- ------ -7 -` w: DATE `i Alterations and/or recommendations---------------------- -------------- ----------------- ------------3--------- -----:•------ -----------------•-------------------------- ------- --- --------- -------- 7; t . � -------i------ -- ------------- - �- = � � ------ --- ----- ----- ------- ----------- ---------------------- 1 --- . ..- t D ----- ---------- -------------------------- FINAL INSPECTION BY:_. - - a+e ,._.$,,. L' SAN JOAQU,IN LOCAL HEALTH DISTRICT ._ 4� 1601 E.Maxelton Aver 300 West Oak Street`'"_1`4 *' X Z Sycamore Street 205 West 9th Street N ` �: Lodi,California Manteca,California Tracy,California Stockton,Cdlifomia E5 B REVISED 6-59 3M 3-'63 F,P.CD.