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F OFF E USE" APPLICATION' FOR SANITATION PERMIT Permit No: :..1_ _.. " r [Complete in Duplicate) Date;lssued ._'y_ �- - _4 _ ----- ------------------ This Permit Expires 1 Year From.Date Issued 1 P tto-D 1 Afplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thisapplication.is madein compliance with County Ordinance No. 549. Iia S ��d sr-y'► ---------------- --•----- - ��f�-----`� ------------------------ JOB"ADDRESS- ._.__ _.. . _ •-"------------- ...,. , Ph One Owner's Name____ ___________ - - ' _ ----------------------------------------- Address --•--- ---------- i Address-------------- . ... . Contractor's Name---- Phone Installation will serve: Residence A artmentHouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: Z_"` Number of bedrooms _ Number of -/.--,Lot:_baths ._;Lot:size --,F-<) ---------------------' ---- # # I' } Water Supply: Public system ❑ Community system ❑' Private Depthto Water Table-_5_0 ft. 4 Gravel Sand Loam Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Character of soil.to a depth of 3 feet: Sand ❑ ❑ Y m ❑ Y } Previous Application Made: (If yes date'----- } 'No ❑ New Construction: Yes ❑ NoNT 'Fl A/VA: Yes ❑ No-E] TYPE OF INSTALLATION AND SPECIFICATIONS: *� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) k00 041$a n k: Distance from nearest well.................Distance from foundation......._.,-_r`___�..Material_-__...._...._-......-_. ......._.......-._-..... th --•------------------- llRR No.'of compartments-- ---------- -----------Size--------------------------------Liuide - - - CapacitY ...� i Distance from nearest well.___-."_...Distance from foundation tQQ.....Distance to nearest lot line:................ Number of lines----- 9 ine.---�- ----- ---.Width of trench `�---------------- Number �� 1 Type of filter rnate�iaLsr._ _. Depth off filter material-_,49 length_..._-....._....__-... 5-----�-. :_ line---- 3 Seepage Pit: Distance to nearest well,. Gl.-j...._Distance om fo ndation ..___.Dista�e to neatest lot line_.-"-..... Size: Diameter_ j _ Depth---.,1 -----------: Number of pits------ -------------Lining materia_-_- - . Lr� 1 Cesspool: Distance from#nearest well.................Distance from foundation.--ti;..._ N.Li ing material_ ------------- ----------------- Depth ------------ --- ------ ---------`-- Liquid Capacity--- gals. Size: Diameter'------------------------------ p 4 Privy: Distance from nearest well------ -------�- --=--------------------- ...Distance from nearest building------- -------------- ------------ ----- - �+ ❑ Distance to nearest lot line- ----- ------ -------- --•-------------------------------------- ' i Remodeling and/or repairing describe):..---------?�------- ' -_-------------------- ---------------------- ----------------------------------------- - - ---------------------------------------------------------------------------------------------------------------- - -- --- - --•------------------------------ ------------------------•------ - _-• - -------------- ------ ------ ----- - - ----- ----------------------------------- ---_---------`ft------------------_--------------- h Sa I hereby certify that I have prepared this application and that the work will be done in accordance wi+h Sen Joaquin County' ordinances�_5� t a ws, and rules and regulations of the San Joaquin Local Health District. } w and/or Contractor) (Signed)- wrier �1 _ ----- -------- . .. �" ---[Title}- e� By:---------_----------- ---------------- ---------- _ `�'g P (Plot pian, showing size f lot, Iota+ion-of -syster'rtJ'_n. relation to wells, buil s,-e+c., can.be. laced on reverse side). # FOR DEPARTMENT USE ONLY I u APPLICATION ACCEPTED BY---- `------- -I-------- REVIEWED a- - DATE------- r 1 f G REVIEWED BY----- -------�------------------------- ------------ -----= ----------------------------------------------------- ----- DATE------------------------------------------------------------- DATE -------- -------------------------- DATE-----:---------------- -------=---------------- BUILDING PERMIT ISSUED----------------------------- -- ------- -_ s , w �� � ..� Alterations and/or recommendations:. ... �G ttC�` ----------- ---- ---- ---- ayC�sY�c � lC" 'rrr f�. C --- --- ----" 1 -Cti/' ...--..... i ------------ .�'«`h f' -� ` wf = f' � f, '------ "T--------------------------------------a - -c..'--------4------------------ Date � -�- Z. 5.—�L. -' .r� = r�C- -- : ---------- ---------- ---- - FINAL INSPECTION BY:...A f--.----rNJOAQUIN Date--------- - ----- - - --•�-- --- -----R ------------ ---------- - / LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 911%Street Lodi,California Manteca,California Tracy,California Stockton,California CS 9 REVISED 8-59 3M 3-•63 "'Co' ti