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FOR OFFICE USE: -------------------=------------------------------------ APPLICATION //' FOR SANITATION PERMIT Permit No. __/-._llJ. .. (Complete in Duplicate) Date Issued _:____ ----------- - - -------- -- --------------.__---------.__. 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 des Iribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OCATION-_-- '_ Owner's Name 4 f r --- Phone .------ Owner's -------------- -----1 � Address �l :=' -----------------•------- '=-------- 1 Contractor's Name ![ I°"' Phone.. -= Installation will serve: Residence ,J©Apartment House ❑ Commercial C] Trailer Court ❑ Motel y❑ Otherdr ❑ ' Number of living units: __/____ Number of bedrooms S.. Number of baths -- Lot size +_ -fit' -� 11 ;I Water Supply: Public system ❑ Community system * Private ❑ Depth to Water Table Left. , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ©Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Ilf yes,date--------------------) No New Construction: Yes R200"No ❑ FHA/VA: Yes [ No ❑ il. TYPE OF INSTALLATION AND SPECIFICATICNZ-1 (No septic tank or cesspool pq;mitted if-public-sewer-is�ilableLwithin 200 feet.) 0 01 Septic Tank: Distance from nearest wet__''---__Distance from oundation�=aY___-_____.Maternal= - _ ---------------- I ®� No. of compart�ants-- ----------------Size M W.Aquid depth---- ----- p Y� --- Distance to n arest lot line___ __._._-Ca aut Disposal Field: Distance from dearest well. "'^"..._.Distance from foundation___,��____ df--- . POO L� Type of filter materia__ _ _De gth of filter mater _l --------------Total length__—--- _____; Number of li els_____ .. Length of each line___ Width of tre nch. .Seepage Distance to nearest well__'___'_-_.-Distance fron o�'nI f aon � D' to nearest lot lin��`_.__ _ Ni Dia eDp+ =:zE 1 I� ------------- --------------Liquid Capacity----------------------; Cesspool: Distance from nearest well---------------- Distance from foundation--------------------Linin material__.__.______-_- . ❑ Size: Diameter--------------------------------------De th---•-------- - ---- ---------------gals. Privy: Distance from nearest well ______--------------_----------------------.----Distance from nearest building--------------.------------------..______- ❑ Distance to nearest lot line----------------------------- - q 'r 1 - r Remodeling and/or repairing [describe):-------- --- ------------------------------------------------- ---- ---------------------- ---------- � -----------------•-•--•------------I------�--------- -- ----------:----------------------- ----------------- -- ------------------•------------------------------•---------------------------•---------------------- If Y y ";- -t-- `gyp--------------------------------------------------------------------------------------------------------------------- ---- � k I hereby certify that�(h-ave 'and regulations Thisali ate San Joaquin wo Healthle don stn accordance with San Joaquin County ordinances, State laws, a f �. h (Signed i /-^�/ ( dit�r Contractor) f _________________ ________ + waifs buildings, etc. -can be laced on �de�. p ` (Title)- (Plot i I P -- --- ----- -- � r (Plot plan, showing size of lot, location of system in r t n o g ` FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------- -------------------- ------------------------------------------------------- DATE------------......---=------ `<-- BUILDING PERIvI:IT,ISSUED_1----------------------------------------------------------/r- ----------------- DATE-----------`----------- -----.. - ------ REVIEWED BY-_---------------- ----------- ----------------------------------------------- DATE--------- Alterationsand/or recommendations------------------- ----------- -------------------------------------------------- ------------------------------------------------------------ -- ' ------ --------------------- - ----------------------------------------------------- ! -----------------------•---------------•----------------- -------------------------------------- ---------- ----------- ------------- -- ----- �e ,: F ----------------------------------------------------,-- ----------------------------- ---------------------- - ---------------- ----- ---------------- ---- -- ------------------------------------------------------ - ---- Date / -- -- ----------------------I�'i ---- t I FINAL INSPECTION BY-------- -------- SAN JOAQUIN LOCAL HEALTH ,Dm�IST{RICT 1601 E.Hazelton Ave. 300 Weat Oak Streot 1 Y4 SycamoretStree+ 205 West 9th Street i Lodi,California r Manteca,California Tracy,California Stockton,California ES 9 REVISED 8-59 31A 3-'63 F.P.CD.