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FO OF ICE USE: �. = APPLICATION FOR SANITATION PERMIT Permit No. _...._.. G.. - This per (Complete ,n Duplicate) __ ... t Date Issued.._. `_�� `� `�/_�. 1. mit 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. 549. JOB ADDRESS AVLOCATION_I�t_ - - - "'Owner's Name--- OU -- ----------' -------------------------------------------------------------------------- -------------- Phone.................................... Address---------------------- ...-------------•--- ---................ -0.............----•--•------.--- -------------------------------------------------------- ......----------------.----- Contractor's Name----------------------------------------- - ----�---- Phone �2_ ®<-- Installation will serve: Residence 2"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other�❑ Number of living units: __1-- Number of bedrooms ._='? Number of baths _J.. Lot size .___1_Q__-_-!'i_1�!.'.r.�.r9q..---------------- Water Supply: Public system ❑ Community system ❑ Private x Depth to Water Table 6.0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Ta k: Distance from nearest well.s�.�._tDistanc from foundation__/_Q....---.Material _!---:__"._.__ Sept � ` (�/ No. of compartments--_.__O.2_______________Size/.__� .59_._Liquid depth__��----------------Capacityl -Q_d__ Disposal Feld: Distance from nearest well+50._..-__._Distance from foundation./.4P............Distance to nearest lot line........... Number of lines___.____ ©�.______ Length of each line____ S�__ S_�:Width of trench.._-__/�.' ;................. Type of filter material__V-. _ _Depth of filter material --___---Total length_..._,l__s Seepage Distance to nearest well ----------- from f undation.3_D.____.___.Distan�e to nearest lot line.-��-�__._.... Number of pits_--o2--__--_-_._Lining materiaL�6'cC_._Size: Diameter-----41-a -10-/D epth____---;Zsi-__------___---- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------.------- Dept A ❑ Size: Diameter--------•-----------------------------De th----------------------------------------- ----------Liquid Capacity----------------..........gals. Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line--------------------------------------------------------------------------------_-------------••----•----•---------••--------------------N Remodelingand/or repairing (describe :---------------------- -----------------------------------------------------------•---------------------------------------------------------------------- b -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- 'h1 -------------------------------•-------------------------------------------------------------------------•--------------------------------------------------------------------------•---------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance Ofate laws, andftiles and regulations of th an Joaquin Local Health District. a T (Signed)-- i ----fw__ L�yV ( caner and/or Contractor) 0 f �lC By:------------------_------------------ •"=�'�f lTi+le) ----- Plot Ian, showing size of lot, Iota ion of system in relation wells, buildings, etc., can be placed on reverse side). ( P g FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----fes. 9 `'` =--------------------------- DATE. =1 % REVIEWEDBY--------------------------------------------- ------------------..---------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---- � ---- DATE-------------- --- --------------------------- Alterations and,-Qr recommendations ` L .�-- -.-f`' � ' --•-�-� �'-- -- '`-``--� --•------- /2 t { / �_ ) s�--- - ` ;--- �jf C---------- i•- -- - -I.....-•-----•--•-•-•...... -----------f ----••---•- ---•-- -------•-------------•--------•--•-- •-------------------------•-------------- ---••--------•--••---------•••---------------------•---------------------------------•---------•----------------------------- ---•-••------ ---------- ----------- -•--------•--••--------------------------•-•-----------•-------•---------•------------------•---•----------••----------------•------•------------------------.............. ---•-------•-----------•------•-----------------------------•------------ -------------------•------••--------•-•--------------•------------••----•---••----------------------------•------------------------------ FINALINSPECTION BY:...-A ----------- -------==--------------''------ Date...----- ----------------y`------------,�--'------------------------------- AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 0 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 3M 3-'63 F.P.CD.