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- R OFFICE USE: ------------. ermit --• , r APPLICATION FOR SANITATION PERMITs P ��No=. ---1•?jf Z` (Coal %ferin'Duplicate) ----------- - ------------------------ - _ -- Dat IsSued. .. `� L_ ..- , •�, " This Permit Expires 1 Year From Date Issued w Application is hereby-made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This apcation is fade in compliance rnrith County Ordinance No. 549. Cat do/� O't �,�1 JOB ADDRESS AND OCAT ON-•• --- ------ �° .. "M -----------------------------------------------------=----------------- Owner's Name--- ------ �k= •----" --------------------------------- --------- ------ 4V ---- Phone ---• ---------- '----- -- --•--------•--- Address-------- - -----------------••--------• ------------•------•---'-------------------------••----•---__----------------- ••••• ------ Contractor's Name------- ----c --r -------- Phone / / Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court (] Motel ❑ Oth r Number of living units: ,:;�--- Number of bedrooms -,�/ Number of baths Z"_ Lot`sizes ----------•-------•--------------- Water Supply: Public system ❑ Community system ❑. Private gJ-16epth to Water Table4��- ft. Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam El Clay Loam [j Clay ❑ Adobe Hardpan E] Previous Application Made: {1f yes,date------------ .-.....1 -No New Construction: Yes RR-'No ❑ FHA/VA: 'es g-No [] t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f I 'ry Ya • ��-• ----.Mate Fa f%��' Septic Tank: Distance from nearest w�eril__��_.Distance from�foundat4ion___ __ ------- --- --------------�- ----� No. of compartments_ -----------------5izea� , 1� _, __Liquid depth-----�1�_,n;--------------Capacity�s> ��--•-- Dis c'sal Field: Distance from nearest weil__� :._Distance from found - ------------- Number �-.,___.Dista ------- Distance to nearest lot line__ _ i P^' Number of lines---A -- _"__-- Length of each line--:40P�-_______. "".Wwidth of trench_A- --- - j-r lS Type of filter material __ C Depth of filter rnatsr3al__ ---=-F"Total length__1�L'_"_----_L-�" ------� / �Cf Seepage Pit: Distance to nearest well_ ------Distance fr m fo ndation_,r2�___ ___..Distanc�to nearestglotine_b✓_w_______._ [� Number of pits_""r--------------Lining material _-Size: Diameter__ __..._°.Depth s"s em---- i Cesspool: Distance from nearest well_________________Distance from foundation fining material_---_._____."____..---__________.___ ❑ Size: Diameter------ ------------------------- Depth-...-.------ `` = -----Liquid Capacity- ------------------ -gals. W I Privy: Distance.from.nearest well-------------------------------------------------Distance from nearest building_:_----__..__--_________I---------------- ❑ -------- - Distance to nearest lot line------------- ---------------------------- -------------------•------ and/or repairing ....... ___.. J _. -- - Remodeling P g1-7-4/�" ------ - - -------------- ------------------"-----------------------•------------------••-------- ---------------- i = -----------------------•----"-----------------=--------------- ---------- {� I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County > ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, (Signed) --- --------------------- C t t � -- --------------- ------ ------------ �{ r on roc ------- ---(Title ------------------------- ------ -- -- -- ----- ) i�� ... (Plot plan, showing size of lot, location of system i ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY :--- -------------- DATE-—Z) APPLICATION ACCEPTED B�Y -l�L ------- -- -- ----------- REVIEWEDBY ----- - DATE-----------•-------------------------------------=----------------- ------ -- --= ------------- -------- DATE-------------------------------- -------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------- - ---- ----- ------------------------------ Alterations '---------- ---------T DATE Alterations and/or recommend4tions:-------:___7:�1 -------- =/ 4 - (�.� Cts-sZp t ti i ' :v ------- h-� ------1 -- , ry—� j -7 -z , a"- ` - --- ----------------�--�"'------- -------------- ---- ..0 ! —�� --------- --- _--- -------------------------------- `"-�' Via-= ` T Gtr+`--- f�J r� FINAL INSPECTION BY:.--- = ,-_"-_ - -------------------- Date..--- 1.-. SAN JOAQUIN-LOCAL HEALTH DISTRICT , 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street; 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISr:D B-59 3M 3-'63 F.P.ra.