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OFFICE USE: ' 1/��tea " ` - Permit No. ................... APPLICATION FOR SANITATION PERMIT �o w (Complete in Duplicate) .�_ Date Issued i 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 described. This application is made in compliance with Count Ordinan No. 49. ---------- i JOB ADDRESS AND LOCATION, f ' Ph -------------------------•---------- Owner s Name--___ / • � -----•----- ------ ---------- y one I Address_----•---- - - - ------------------------------- Coritractor's Name ------- •-_.-..- - _ v � . �. - - Pone..--------••----•---•-----------••- R2 - "� El Ofiher El will serve: Residence [�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel A4 Number of baths __�_ Lot size ---A42W-,q-6- "• Number of living units: __-�--- Number of bedrooms _� --- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table __-.___. ft. � Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cla_y, ❑ Previous Application Made: (If yes,date,_-----------------) No New Construction: Yes ❑ No LJ` rHA/VA: Yes ❑ No PP �. f TYPE OF INSTALLATION AND SPECIFICATIONS: r , • (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well_..--.--Distance from foundation_��____--_----Mat erial__-._�_�,__ ,pacity'?�?Q `---°-�--- ------- Septi : -- p ------ - Size_ X / q P.No. of compartments-__� _��------ ---------Li uid de th__ ___-_--__.---._ -- Disposal eld: Distance from nearest weil__�'_-__----.Distance from foundation_ a______________Distance to nearest lot line_S_____------- Len th of each line--_ .------=---- Wid#h of trench.- _ f_,-•---------------•-- Number of lines------- ------------------- ag a r t Type of filter mate riall2G- ------Depth.of filter,materia!__� ______F-____To#al length____1 a----------------�; Seepage Pit: Distance to nearest well__________________ D.iStan c�om foundation---/P----------Distance to nearest lot line.__------- Number of pits----1-______________Lining material____ _ ---Size: Diameter._ . - Depth- - 71 1 Cesspool: Distance from nearest well___--_____ Distance from foundatio - Lining materia4______________.____.___________-__-_. _Li uid Ca acit gals. Size: Diameter--------------------- --------------Depth------------- ------- ------------------------ q P Y -------------- I - ----------------Distance from nearest building---------------------------------- ----- Privy: Distance from nearest well_________________________________ ❑ Distance to nearest lot line-- --- - ij zRemodeling and/or repairing (describe):be�:____-.- R ----------- ` ------------------------------ ----------------------------------------------•-- ------------------- P ---•-----•----------------•--------•---•--- - I hereby certify that-I have prepared this application and th the w will b done in accordance with San Joaquin County - ordinances, State laws, and rules and regulations of the San Jo uin L Healt District. -- -- ----- ------------------------------ ____-_(Owner and/or Contractor) R ----------------------- ------------------(Title)-------------------- --_-_ - - ----- ---------------- ' (Plat plan, showing size of lot, location of system in rela ton t wells, buildings, etc., can be placed on reverse Sid el. FOR DEPARTMENT USE ONLY dx y - <:c d'------------------- -- ------------------- DATE � f '� APPLICATION ACCEPTED BY---_-_-•- DATE------------------------------------------------------------ REVIEWEDBY------------ ------------------------------- ---- BUILDING PERMIT ISSUED -- ---------- - DATE Alterations and/or recommendations:----- --------- ----------------- -•------------------ ------------ �'-------- ---_. --------- �vd �y FINAL INSPECTION BY—: = Date - --��=�-` . � . -�G- ''------------------------------ C� SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street � Stockton,California. Lodi,California Manteca,California Tracy,California L 5 1 y E5 9 REvjsEd 8-59 3M 3-'68 F-P.CO. ,