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ubL: L* ---------------------------- --------------------- -------------- --------------- - - --------------- APPLICATION FOR SANITATION PERMIT Permit No, ./ -------------- ------------ (Complete in Duplicate) ---- -- -----------------------I-------------------------- This Permit Ex fres I Year From, Dale Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des q�>ied, This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-- f_,? Z7 4 -----------g Owner Name---- __7 7---- - - --------------- /4- ------- -------- Address------ --- -------- --------- Phone Contractor's Name_-_-----_ ---------- ------- -- -------11------------ --------------- ------- -------------- - ------ -- ---------- ------- - ---------------------- Phone-------- Im Installation will serve: Residence Apartment ouse 0 Commercial Ej Trailer Court 0 Motel ❑ Other Number of living units: --/---- Number of bedrooms Z_ Number baths __/--- Lot size .__1� ------------------ Wafer Supply: Public system E] Community system [I Private Number to Wafer Table ----------ft. Character of soil to a depth of 3 feet: Sand E3 Gravel E] Sandy Loam [] Clay Loam E] Clay El Adobe le('Hardpan ❑ Previous Application Made: (If yes,date.-_----------------} No E:1 New Construction: Yes El No E] FHA/VA: Yes ❑ No E] 4t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank Or cesspool Permitted if public sewer is available within 200 feet.) Se ank: Distance from nearest well----- Distance fro—mi foundation------/_!2_/_.Mafer1aI Septi No, of compartments-.. i --- ---------- Liquid depth_C;�---------------Si2ea)/( -- ---- -- --------------- ---- Disposa)/Field: Distance from nearest well-_50 / - _�/-- ----------Capacify_.R,9j2�- -- Number of lines----- Z --------Distance from foundation.-- lf,9------- Distance to nearest lot lines/( ------- Length of each line--S --_G 4' of french Type of filter material-- - ___7----------------- - __/---Depth of filter material----- --.-Total length------- SeeGgp/lit: Distance to nearest Distance fr9m,foundafion-----/-,0---/_Distance to nearest lot Iine__S-_f� Number of pits.... m - ----- -pits_...___--------Lining material-_ -------Size: Diameter-----------33_'_'Depfh......;' -r Cesspool: Distance fromnearest weft-----------------Distance from foundation..--- ------------_Lining material-._---_--_----___________------------ 0 Size: Di6meter.__.' ---------------------------- V$ - ------ ---- Privy: Distance from nearest- - -well__________________-- --Depth----------------------------------------------------Liquid Capacity----------------------------gals. El Distance to nearest lot line -------------------------------Distance from nearest building------------------------------------------ --------------------------------------------------------------------- ------------------------------------------------------------- RemodeJing and/or repairing (describe):-___-__-------______---------------------- PF -----------------------------------------I----------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------- . -------------------------------------------------------------------I------------------------------------m------------------------------------------------------------------------------------------ ----------------- ------------------------------------------------------------------------------------------------------------ --------- - - - -- --- - - - - -_ I here6 y certify f h a t I h .0 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I and rules and regulations of the San Joaquin Local Health District. (Signed)-------------------- ----------------------- Contractor) -- ------------- ---- --------I ----------------- By:_----------- ---------------------- --- --- -- - ---- -------- (Plot plan, showing size of lot, location of system in relation to we s, buildings, etc., can be placed--on---rev'e'rse--side).-- ------------------ �DEPARTMENT USE ONLY FOR DEPARTMENT�PWT I�Icpnk.. APPLICATION ACCEPTED BY-- ----- ' " - : --- ----I---------------------------------------- DATE--- REVIEWED BY------------------------------ ------------------------------------------------------ DATE.----------------------------------------- --------------- 13UILDING PERMIT ISSUED Alterations and/or recommendations:--____..---_---.-_______ --------------------------I----------- --------------------------------------------------------------------------- ----------I--------------------------------------------------------------------------------------- ------------------------------------------------ ------------------------ -------------------------------------------I---------------------------------------------- ------------------- --------------------------------- -------------------------------------------- --------------------------- ------------------- -----------------------------------------------------------------------------------------I--- --------------------------------- ------------------- ----------------- -------------------------------------I-------------------------- -------------------------------------------------------- ------------------------------------------------------- FINAL INSPECTION 8Y: ------------------ - Date...:!�;?--7 ----------------4-------- --------------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Av&. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 8-59 3M 3-'63 F.F,Ca.