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APPLICATION FOR SANITATION PERMIT Permit No. ...Ai/ 3z...7 ' (Complete in Duplicate) `0a�� , This Permit Expires 1 Year From Date Issued Date Issued .______ ____.__. Application is hereby made to the San Joaquin Local Health District o perm' to construct and install the work herein described. This application is made in compliance with County Ordina .i5t . JOB ADDRESS AND L ATION.-._ -------- -- ------ Phone--------------------•-- - -��-� -- --- --•--�� Owner's Name------------- �-------- -�------ •-----°�------- =----- -------- -•-------- Address----------------------- -- ---- � � -- -- ' -- ------ --------- ---- - ------------------------------..__...-•------------- - -----•--••--- Contractor s Name-- -------- ------------------ Phone. - Installation will serve: Residence Apartment House ❑ Commercial ❑ 'Trailer Court. ❑ Motel ❑ Other El— Number Number of living units: 1--.__ Number of bedrooms J-_ umber of baths ._l. Lot size _._ ' 'l° ----------•---••-- Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table yeL ft. 1 I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam[] Clay ❑ AdobeHardpan ❑ Previous Application Made: Yes ❑ No U1 New Construction: Yes ®Klo ❑ FHA/VA: Yes e--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well Y_. _ `'Li -- de th_Material-----&--- __-Distance from foundation___ -----. No. of compartments---- -_'- --------Size ----x-V-( .--- q p. �� P y-•,zf� *59------ " r Disposal Fi Distance from nearest well __Distance from foundation lA y`Distance to nearest'lot line.-.- Number of lines---------� _ Lengthf of,each line_____, _____.Width of trench .kf` Type of filter material, Depth of filter material . . "! . Total length.__._/ !_______._. I\ Seepage Distance to nearest well `"- '. ---.-_Distance f om 'f dation....Zt9.7?`'..Distance to nearest lot line--- - Number of pits_------s -_ _. __Lining material_ _Size: Diameter_ � -_ _Depth__�' ,�_�_____ _________ .,,�-:,,-,.-_-.:.rte:_.. t Cesspool: Distance from nearest well -__ --Distance from foundation Uning material- ---- -_ ❑ - - Size: Diameter__ Liquid Capacity gals. ........................... Privy: Distance from nearest well-.--. _ Distance from nearest building------------------------------------------ F] __-_--_❑ Distance to nearest lot line----- ------------------ --- ---- ------ - •- - ----- -- ------------ - -------- -- J ------------ - Remodeling and/or repairing (desc'ribe):----'- `'� �j --- --- -��==`-; -- -- - -� � — ------------------------------------------ - P ri _______________.--_-__--•-__._-_--_-_-.__---__-__ ___-__--__.--__-___-_---_____.___.______.__ F , ----- ---_------------ --= ------------------------------------------------------------------ - _ _ ordinahereb certify and Ihave and - s - a - y y prepared this application and that the work will be done in accordance with San Joaquin County regulationsate of the San Joaquin Local Health District. i F "'��(Signed)_ v- -------1 2 -------------- ---------------------------------(OG&nP---- �."'bra Contractor) --------------- --- BY' = - ----------------------- ' ��¢I (Title) r` �' - (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY — APPLICATION ------ --- DATE --------------- APPLICATION ACCEPTED BY. _ .____ _ __ 4 -• REVIEWEDBY--------------------------------- - - --- ---- --- --- ------------ - ----- DATE - - - ---------- BUILDINGPERMIT ISSUED---------------- -------- ------------------------------------------------------ ------ DATE - --- ---------------- Alterationsand/or recommendations------------------------------ -------------------------------------------•---------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -_.-_-----------------------------------------------__-------__4__.__.___.__._ _____------ ___-- --------.---------.-._.-__--__-_--__--_---_-.-._---_----_-•____,--_-_-_-__---_--___-__.__._______--____-_.._-----_ r __________________._...__._...__._.__..___-..__ .----- .-------__._.____ _ _ . . _.. _ --------------------------------------------------------. _ _ _ _ ______________________________________,r .. __... ------------------.�. ___ __- .-___ ---. .. ------_-.--.---...-___-_-----.--__.-.--:......--.--___-.----_-__....--____.__..__.___--__-----_--_-_-._.__--_- FINAL INSPE�TI•©.N BYE _ _�.: - - - Date---. -- _7. .- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT r, } 130 South American Street '`1''300 Wes+ Oakf Street) f`�°%'i s -J 32 Sycamore Sf Street ,�7 f 1814 North "C" Street ~' Stockton, California Lodi, California , Manteca, California ' Nracy, California ES-9-2M Revised 8-'59 F.P.Co. r'