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OFFICE USE: I 91 € - �-� � - - f 4 APPLICATIOPf FOR SANITATION PERMIT Permit No. ......//7 `///1 ------------------------... --------------------- Y` � . 11: k {Complete in _ This Permit Ex fires 1 Year Fram Date Issued Date Issued 1 _ -__l �+ ------------------------------- 11 1P is hereby made to the San Joaquin Local Health District for a permit to construct and ins+all the work herein described. a This pplication is made in 'Compliance with County Ordina e No. 4 . L/ JOB ADDRESS AN LOCATION......... r -----------••------------- Owner's Name__._._ � Address--------��•--�-----��- one---- -�_s--------------- ----/ ------ --- - ------ s Contractor's Name,------------------- f Phone ----------- --- - t Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units: .f ___ Number of bedrooms A -- � r�____ Number of baths'��__ Lot size ._�.C1__ __�_�_S•__ Water Supply: Public system,(� Community system ❑ Private ❑ Depth to Water Table lD ft. Character of soil to a depth of�3 feet: Sand Gravel Sand Loam Clay Loam Clay III E ❑ ❑ y ❑ Y ❑ y ❑ Adobe W Hardpan ❑ Previous Application Made: 1(If yes,date_�-�_. _ _ __) -,No ❑ New Construction: Yes ❑ NoFHA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I x (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,-4 I� '1 i epti' nk{ Distance` from nearest well________________Distance from foundation__-______-____._-_. Material_________________._ ' No. of compartments--------------------------Size--------------------------------Liquid depth----- --------------------Capacity------ i po I el d. Distance;from nearest well-------_----------Distance from foundation___.__..__.________.Distance to nearest lot fine_______-.____.___ t Type of�lof'lines ----------------Length of each line --------------------- =' Width of trench ►/I Number!of ------------- filter material-------------------------Depth of filter material_.------------------------Total length---. ---------------------------Pit: Distance.to nearest well_�j� p.. +l� i-----Distance om fo dation___ Q:.._.f,.Distan ce to nearest lot line_______________ dumber:sof pifis__..__�______-------Lining material___k;n Size: Diameter.•_.. 3. De to . Cesspool: Distance;from nearest well_________________Distance from foundation--- Lining material__.--__._.-_..-______._ __ ❑ Size: Diameter----------------- ------Depth-------------------'-------- -Liquid Capacity gals. a_ , . Privy: _ Distancelfrom nearest well :_ _ y_--j___':_________:___________________Distance from.nearest building i i r 9 -'-' ❑ Distance'to nearest lot line._.-�_____________'`_,---_____..:_ If '------------------- _ T Remodeling and/or repairing [describe]:_________#------------ - .. �. =- --------- ------------------------------------ ------------------------------------------ - �� g•----------------•------••- .. ' ----------------------•------------------------------------------------•----- ---------------,----------- - I hereby a ify that I have prepared this application and that the work will be dohWin accordance with San Joaquin County ordinances, t to laws, and rules and regulations of,the San Joaquin Local Health District. {Signed) 1-- --- - - - ------ _ ._ _ ------ - gY•--------------------•-----------�•--•--•-----...----------=---- - ..,� - - - r Contractor) , - --- --- n d/o Title (Plot plan, showing size of lot Focationfsystem n relation to wells, buildin s, etc., canbe"placed on reverse side). IlkFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____________ _ _ r.. "`G' DATE 1 ___le r --------- ----------------- BUILDING --------- - -- ------------------------ AI#er II' ----------------- DATE!------------------------------------------------•--------- BUILDING PERMIT ISSUED---:--------------- f4fC�---------- --------------- FE rz- DAT -------------------- rat and/or Pc_ -��.._- � ,�yyam� '/�—.. 1a : �`� - .--------------- _ F FINAL 1NSPE !ON BY:. -'E- . ----------- % Date_--'------- -`� SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street j 205 Wast 9th Street Stockton,California Lode,California Manteca,California Tracy,California ES 9 PrVf5E0 8-59 31A 3-'53 F. ,CO.