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R OFFICE USE: m ---- ----------------------------- ------- ---- -__-_---____---_-_-___----.-_----------------- :\\APPLICATION FOR SANITATION PERMIT Permit No. ....-_--'---3.z- -------------------------------------------- (Complete in Duplicate) - Date Issued ___.9_'.`E_-_�3 _________________________________________________________ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. �,� JOB ADDRESS AND CAT ON---- �.��---.�41------'-------------------------------------•------------------------------------ Owner's Name r.. ,r if , -•-------------•-•--------------------------------•-----•---------------------------- -- Phone------------------------------------ lf k LLLl.� Address .---• � 1 --------- ---'-------- --_---------------------•---•--------------------------------- - - Contractor's Name.--•-i�- . •-------- ---------------------- Phone ---------------•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Z_.. Number of bedrooms 0--- Number of baths Z--- Lot size __!. /r�i .� Water Supply: Public system Fe"Zommunity system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R-lHardpan ❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes 0?<o ❑ FHA/VA: Yes Fr—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)` a Septic Tank: Distance from nearest well ___Distance from f undafion_-.�Q--_----__.Mat rial_ —j!r-_�� `_..__ No. of compartments._.. Z--_____---__...Size. ' . 4'.___Liquid depth-__;KA4_.__--.-___Capacity.. Disposal F' Id: Distance from near well------------__Distance from foundat' n.`.XDistance to nearest lot line-_ 'P--�...... i Number of lines_____ ________ ______ _____ ___Length of each line_- - -�- Width of trench ._ ..___,--------------------- ow _ --_---- -___ - ------ - ---- -- Type of filter material_ --Depth of filter material . �_-y_-_ Total length._. V.-__:________________________ W �` Seepage Pit: Distance to nearest well---------- -__-Distance from foundation,/ _-____.......Distance to nearest lot line--S---/--__--- Number of pits-_--.__?------------Lining material__S_QSize: Diameter-3—$_!Y--------Depth---j Q..-7_!--------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-----_--_-_---._._-_.-_--._____--__ ❑ Size: Diameter------------------------------------- Depth----------------------------------------------------Liquid Capacity.----------------------_-gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------._-__.__----. ❑ Distance to nearest lot line----------------------------- ---------------•-------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe) �Q ---------- �___V_o -)-------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------•------------------------------•-----------------------------------------------------------------...---•••--- --------- ----------------------------------------------------------------------------------------------------------------------------------------•----------- -------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rul d regulations of the San Joaquin Local Health District. (Signed)---------AOAI�o ------- ----- -- --------------------------------------- --•---(Owner an /or Contractor) By------------- -----•---•- _ . -•-•- ---�---------------------------------------------------------------( e)(Plot plan, show' of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------ez- e;00---- -------------------------------------------------------- DATE--------t-"-t4_j�=.G3------------------------- REVIEWEDBY-------------------------------- --------------------------------------------------------------------------------------- DATE............................................................ BUILDINGPERMIT ISSUED...................--------------------------------.........--------------------------------------- DATE------------------------------------------------------------- Alterationj and/or recommend ions:__________________ - ------------------------ !�' r � - ' ... . .._ -------._ __:_ _ .,ol------ �_x ----------------- --• . -------------------------- ------------------------ ---------------8�- 7`6-3----- � ---- ---------------r---------------------------------------------- -- FINAL INSPECTION BY:.-------L ------------ ...... Date----- --------------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.OD.