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FOR OFFICE USE: --------------- --------------------- --- --------------- APPLICATION FOR SANITATION PERMIT Permit No. ....•_-.2._...4?, -----=---------------------•-------------------- - ------- .(Complete in Duplicate) J .................. ...----.._.. This Permit Expires 1 Year From Date Issued 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 compliape with County OrdQnan - I�fp.i,5�4 t �i JOB ADDRESS I AND LOCATIO = _ ": F�:' t: ----------------�--- � ..........., : Owner's Name_.!_Mi? 5. a ------------- LL �------------- ------------ -� ------------------------------------- Phone-------------------------- Address -----------------=--- - �.p_N_�._'.1_ Address------------- ------ ...........----------------------------------------------------------------------------------`---------- ff �/7e � Contractors Name-----Qq_eC1/_ ---------- /-•Q. lx' Te 13,--- yid Phone Sf/:..7 -----••--------- Installation will serve: kResidence W Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number,of living units: _J-_-- Number of bedrooms 3---- Number of baths ./---_ Lot size..__ Y--< ------------------------------ Water Supply:.: Public system ❑ Community system ❑ Private ® Depth to Water Table --- Oft. Character of soil to a depth of 3 feet: Sand (Gravel 0 Sandy Loam ® Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote_----------_--------) 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.) =-^ -�• — - 4 A -� Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material--------------------------._---__-----__._-_. ' No. of compartments--------------------------Size--------=-----------------------Liquid depth----------------- --------Capacity--•-------------------- Disposal •---------- ----- Disposal Field: ;' Distance from nearest well- 15—J Distance from foundation----/ ---_.----Distance to nearest lot line-- ________. EX[5Z`ItJ(Gr! Number of Lines------------1.___.._----�----/-----Length of each line------ � --- --;--------.Width of french...___.3- ------------------- •}— ADD Type of filter material-----�Q_�'fi___---Depth.of filter material----/.,�-------------Total length---__--`,_4_____._--_--_-__.-_ ------._ Seepage Pit: Distance to nearest well_.__/_46---------Distance from foundation.---f -----------Distance to nearest lot line---� ------- Imo` Number of pits-------/------------Lining material----/��.�_e__.Size: Diameter-----�`-------------Depth........�4�-----------.-------- Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material-- Size: Oiameter--------------------------- - --- --Depth--------- ---------------------:----------- --------Liquid Capacity------------------:---------gals. Privy: s- Distance from nearest well------------------------------ --------------Distance from nearest building_____.___________._________ ❑ Distance to nearest lot line________________________ ` Remdeling and/or repairing (describe)-------------------------------------------------- ------=-------------------------=---------------------------------------------------------------------- -----------••---------------------- 1IlF(�/ L71r A/�tl --- --------- ------------------------------•------------------------------------------•-•----------------------------••-•--------------------......................------------••--------•--------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ ------ 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. ��Y --------------------- ---------------------------(Owner and/or Contractor] (Signed)------ .._ BY --- -_L2-= -- _ __ rte-�---------------------- ------------------- _ (Title) �� /U -'��✓ t - _ vr.•.,w.Y, .J�..._ (Plot plan, showing size of lot, cation of system.in relation to wells;buildings, etc.,.cari be laced on-reverse side]^ a FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY-----71___1_ - _a-------------------------- --------- DATE - 3 ------ I REVIEWEDBY-------------------------•-------------------- ------------------------------------------------------------------------------ DATE-------------------= -= i, BUILDING PERMIT ISSUED-_._ ------------------------------------_ DATE 1' Alterationsand/or recommendations------------------ ---------------- ------------ ----•-=----------------------- -------------------------•-------•-•-------------------- -----------------•-------------------------------------------•--------------------------- -------- ----------------------------------------------------------- - -- --------------------I---------------------------- - s --------------- ----- ---- ---------•- - --------------- ------------------------------------------------------------------- - ----- -------- FINAL INSPEC ON BY: - --- ----- -- -- ---- T Date----------- ------------------------------- SAN ------ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 3M 3-'63 F.P.CC.