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;V 4-UR UI-FICL USt: t n�_ E APPLICATION FOR SANITATION PERMIT Permit No. ...ZZ . +°l-_- --------------------------- --------------------------- (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 i'600 or�descil6e . This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION i =` -- y! -1---I/'` ` Owner's Name-------- 5 Address._.._.___ . y - �- f ---------- mac. Contractor's Name-/ ..��.L %C�_�'�n'v ! _�r ./, i;l J` f i ----• --- ------------------ Phone-------.--- Installation will serve: Residence ❑ Apartment House ❑ yCommercia11 ❑ Trailer Court [] Motel ❑ Oth • r Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size � � �_____________ ________�-------._ Water Supply: Public system E] Community system E]- Private [P Depth to Water Table t!;q ft.v Character of soil +o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ] Hardpan ❑ - Previous Application Mader (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.) Septic Tank: Distance from Weare ell-S"4'___--Distancg;f om fo ndation__f©'_------MaterialA� L ---------_ ------ No. of compartm . ent _ _.__ __._Sizev2._..-- _fY•Liquld depth_______ _______________Capacity _.--- Disposal Field: Distance from Ae rest well-s)_4'....._-__Distance from foundation---22----------Distance to nearest lot line-- ------------ E _ .....:.._ _ Number of lines. ------------------------------Length of each line-,? Width of #rench__._,2____V,---------------------a Type of filter rnateri Depth of filter material_.) '!..-------Total length__�ZC0_________________________.-_-_ Seepage Pit: Distance to neatest w 1.___._______.______Distance from foundation--------------------Distance to nearest lot line----------------- .� Number of its-----------------------Lininmaterial-----------------------Size: Diameter.....------------------Dept k-------------------------------- Cesspool: Distance from nearest well------_----------Distance from foundation___----------------.Lining material-------------------------------------- ❑ Size: Diameter--- `----------------- ---f----------Depth--------------------- -------------------- --------Liquid Capacity----------------------------gals Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line......----------------------------------------- --------------------------------------------------------------------------------------------- #.. Remodeling and/or repairing (describe)-------------------------------------------------------------------------------------------------- ---------------------.--------------------------------- G -----------------------------------------------------------•--•--------------------------------------------------------------------------- -------•------------------------------------------------------------------------ -- -- ---------------------------------------------- ----------------------------------------------------------------------------------------------------- ----------------- ----------------------------------------- -- �+ F ----------------------------------•----------------------------------------------------.---- -----------------------------•--------------..-..---------------------------------------------------------- ------- -- P hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance , to la ,a nd rules and regulations of the--San Joaquin Local lHealth'District. 0.. (Signed)----- . . --�----- = -- -------------"---------------------(Title)---------------------------------------------- -------------- dF (Piot plan, sho ing size. of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). Il. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY r ------------------------------------------------------- DATE - REVIEWEDBY ------------ ----------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED---------------------------------------------------------•---------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------- -------•----------------------------------- - ----------------------------------------------•-----•----------•---------- ---------------------------------------------------------------- -------------------------------------- --------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------•---------------------------•-------------------------------------------------------------------------------------------------------...---•-------------------------------------------------------- --------------------------------- -- ------------------------------- ------------------------•----------------------------------------------------------------------------------------------------------------------------- - - -- ---- - -------- ------------ - -- rs-'.'�_,.--u=._:-�..!.�.cT.;�----------------- ------ - Date--�'�'-�'------`�°--�-- L :` FINAL INSPECTION BY:-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 1.kaselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 31A 3-'63 F.P.CC. -