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lUKUt-HLL U5E: -------------- -------------------------------------- -------------- -------------- ----------- -- --------------- APPLICATION FOR SANITATION PERMIT Permit No. ................ T7, ------------ - ----------7---------------- -------------- (Complete in Duplicate) ---------- ---------------------------- ----------- -- This Permit Expires I Year From Date Issued Date Issued ---- Application is hereby made to the San Joaquin Local Health District for opermit to construct and install the work herein described, This application is made in compliance with County Ordinance No. S49 JOB ADDRESS AND :_1------------------ ----------_ ------- Owner's Name--- ------- ZZ( ---------------- Phone__.----------------------------------- -------------- - Address .2. ---------- - --- --- -- -- - -------- - ---- E] Commercial '�riIe_r__Cour_t__E]-----Motel [I Other E] ---------- i�w e Contractor's Name__-------1!�',a-e-p------ ------ .0 Phone-----_--_------------ C ontr' Installation will serve: Residence d. Apartment�House I T Number of living units; ---- Number of bedrooms ----�__ Number of baths ---?�ot size jliQZ_X----i Water Supply: Public system El Community system' Private 0 Depth to Water Table -------- ft. x Character of soil to a depth of 3 feet: Sand E] Gravel [-]A Sandy Lo Ej,am Clay Loam Cla YA Adobe ❑ Hardpan El Previous Application Made: (if yes,date- '-- - __�--------) No — New Construction: Yes e�� No E] FHA/VA: Yes E];'No E] TYPE OF INSTALLATION AND SPECIFICATIONS: 01 (No septic tank:or cesspool permitted if public sewer is available within 200 feet.) Nell Septic. Tank: Distance from nearest welifflrPg-7-4DistaneJro fou-d <`�� -- _�tion---- �------------Material---1��i -�4 -7-0-0 No, of compartments----7 -----Size- ....:'�Uquicl depth--:------L4.��_._Capacity.__]_ ---------------- Disposal Field: Distance from nearest well-)D*194Distan c-e f foupdatjon___.,;&_/.......Dista'nce to nearest lot line, Number of lines.2----------- Length of iFc1N'�,'_r _Width of trench-.......q, Type of filter material.5- Depth.of filter maf1rP';al__'__ 13�1 7en------------- j-&-d------Total length__--__.-eZ!Tj��....................... Seepage Pit: Distance to nearest well----------------------Distance from foundation---- ---------------Distance to nearest lot line__--___-_____.-_ ❑ ine----------------- El Number of pits-_-----7-------------Lining material-----------------------Size: Diameter-----------------------DepA--------------------------------- Cesspool: Distance from near'est well_________________Distance from foundation---------------------Lining material__-.-._---_____---.___: i---- ❑ Size: Diameter---------------------------------------Depth-------- -------------------------------------------Liquid Capac-ity-------------------- I---gals, Privy-, =Distance-from nearest-�We]L- ------------------------------------D i starncei fromb—b i I al i n 0 Distance to nearest lot line---------------- Remodeling ine--.-------------Remodeling and/or repairing (c1escribe):_.')-_7-------------- ---------------------------------- - -------------------------------------- ------------------------------K-------------3A-------------------------------------------------- --------------------------------------------------F- ----------------------------------------------------------------------;� I-------V_____—----- _1�f - ----------------------------------------------------------- -------------------------------------- -- ------------------------ ----------- ------------------------ 43 ------------------------------------------------------------------------------------------------------ ---- I hereby certify that I have prepared Am applicat acJkY#66 the work will be done in accordance with San Joaquin- 'County ordinanc , State laws, and rules and.regulations of thV'San Joaquin Local Health District. State ___ e" (Signed)--------- --------- ------------------------------------- -------------------------------------------------------------------------------- ------------------(Owner and/or Contractor) By: ---------------------------------------------------------------------- ---------------------------------------------------- I _(Title)-----------------4--------------- --------- - - ---------- o (Plot plan,-;Lw\in size of lot, location of system in relation to wells, buildings, etc.,.can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------------- -- ---------I---------------------------------------------------------DATE------------------------------------------------------------- REVIEWEDBY--------------------------------------------- ----------- ---------------------------------------------- DATE-------------------------- BUILDING PERMIT ISSUED---...... -----------------I-------:-----------------------------------------------------------------: DATE- ------ = Alterations ATE---------- Alterations and/or recommendations---- --------------------------- --------- --------------------------------------------------------------------------------- ------------------- ------------------------------ ---------------------------- -------- ------------------------------------------------------------ ---------------------- --------------_------------- --------------------------------------------- ................. ............ .............. - ------------:------------------------------------ ------------------------------------------------------------I---------- ---------------------------------------------------------------------------- --- ---------------------------------------------------------------------------------I--------------I----------------------------------F---------- --------------------------- -------- ------- ------------------ ------------- -- Date------ .. 6�----:�5 -- ------------------------ - FINAL INSPECTION ------- - -------------------------------------------------------------------:---------- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.Noxotton 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 P.P,Ca.