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FOR OFF CE USE- ................... ........ -------------------,......._.06P.............._... APPLICATION FOR SANITATION PERMIT Permit No. .......................... ---------1------- 1� (Complefe-In Duplicate) ........................ ................................ I 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION....../.....9...,..;.�.Z........ -- ---Phone.--------•----*...... Owner's Name.....----/r-------4, 7.� 7-_ ......-__---------- ------------------------*...--.... ~.-.............-- Address...... ...............Address...... --------- le!i................—4-—1......................................... 4 Contractor's Name........APP-rJ2--- ----------------- ----- ........................ ........I............L_ Phone----•--......................... I Installation will serve: Residence Apartment House [] Commercial E] Trailer Court Mofelj[] Other..- 0 Number of living units: Number of bedrooms Number of baths A... Lot size*Z. --- -------------- " Water Supply: Public system ❑ Community system 0 Private [Depth to Water Table-,� ft� Character of soil to a depth of 3 feet- Sand Gravel [] Sandy Loam E] Clay Loam [:] Clayo Adobe`�HardpanEj Previous Application-Made: (If yes,date...... No New Construction: Yes [] No er FHA/VA: Yes Z;, No E] TYPE OF INSTALLATION AND SPECIFICATIONS; (No septic tank or cesspool permitted if piublic sewer is available within 200 feet.) Septic Tank: f Distance from nearest well,................Distance from foundation....................Material.--- - ---------------------_............. 144114 No. of compartments.............. ...........Size.........................._-.Liquid dep;th................ ........Capacity....................... Disposo F Field; Distance from nearest,.well... Distance from foundation....................Distance to nearest lot line................. kj$1 $ f0ll-j Number oPfines.................I...............Length of each line.. ...................-......Width of french.---- Type rench,....Type of filter material......:.................Depth of filter material......................Total length_....__-.-. ...... ....... ........... Seepage Pit- Distance tornearest welI_A?_.k4.:...........Distance fMm foundafion...-IT .".Distance to nearest lot tv P a Number of pits.../................(thing m terial,,�--- Size: Diamefer.i�P.*I.rk/4pbepth.Z,9.I....._............ Cesspool: Distance from nearest well.4 4 ..........Distance from foundation................. ..Lining material......-_............_...._........._. 1-1 Size: Diameter... ......._........3,-2..........Depth.................. ................................Liquid Capacity-- -......................gals. Privy: Distance fr6m nearest weIA'-A........................................Distance from nearest building......_....._..____-----------.___._----- ❑ Distance tiffearest lot line-..+r----------. . Remodeling and/or repairing (describe):--- ---------------...... ............................................... ........... ............. .......................9 .....................I................................................_............................................................. ................... ................... .......-......--..-...i..---------------..........--------------------•----........... ........................................................ ......... ........ ....................;__.................................----- -- .................... ............ ........ ................................. ................-- I hereby ..Ihereby 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. (Signed).. ..... -_Xo 7a_ 0, - .. ---------- I_e" ". ........ .....(OWNW-0wor Contractor) By:........ -- - ..........._------ ------------- ----- . ...... ... . .. .. ... (Plot plan, showing size of lot, location of s 'on to walls, buildings, etc., can be placed on ravierse side). FOR DEPARTMENT USE ONLY I q v APPLICATION ACCEPTED .........._............................................ DATE.....G-8-68 REVIEWEDBY................................................------------- -----------------------------------*.........._.......... DATE..................._.._....... ..........-- . BUILDINGPERMIT ISSUED-------------------".....**-,*----------*.........------------------ ---_........... DATE_... ................................................... Alterations and/or recommendations:.....................•- ...... ..................................................................... ........................................... ................................................................................................ ............................... ....... ................................................ ........................ ............................................................................... _._.............. ................................................... ......................... ........................... ..........--------------------------- ............... ..... __.......... .. . .................................................. . ...... ................_ ........................................ ............i............ .................. ......... ......... ......... ................-------------- .. . ................ ................... FINAL INSPECTION BY:.. . . ... ..................... Date 0- I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stacklon,California I..& California.'. t. Manteca,California Tracy, California E.H.92M 1 67 TV.n9..H P,.,.