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FOR OFFICE USE f---------------- L : "APPLICATION FOR SANITATION PERMIT.•, _.� Permit No. __4--(0 --� ------ ------- --------- �----------..--------------- - �(Complete. in Duplicate). .� // g This Permit Expires 1 Year From Date Issued Date Issued :_-______ --�'3 t Application is hereby made to the San IJoaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinancy No. 549. { JOB ADDRESS AND LOCATIO,N__ -- deli j6�Lie ( �L �I D'z7. *409ie� t -©-------- Owner's Name - - ------------------------------•-------------=-------------------= ----------- ------- hone ...s_ .9 Address------?_v---- - ------ --- Contractor's Name_ Phone...- --------------•--------------------------------------------- ------------------------•----- Installation will serve: Residence 2trApartment House ❑ Commercial ❑ Trailet Court [D Motel ❑ Other ❑ Number of living,units;w__ ,_+Number,of._b.edroo,ms-: . Number;of baths ___ Lot size� :__ --�X. -_--�----•------------------------ t Water Supply: Public system Commuri iity system ❑ Private ❑ Depth to Water Table _,Kv ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam-❑1 Clay Loam ❑ Clay ❑ Adobe �a'rdpan ❑ Previous Application Made: (If yes,date__________________I No Q�N ew Construcfion: €Yes UrNo ❑ FHA/VA: Yes ❑ . No ®_ TYPE OF INSTALLATION AND SPEC)FICATIONS: ,(No septic tankyor cesspool permitted if.public sewer is available within 200-feet.) Septic Tank: - Distance from nearest well _�-______Distance from foundat of n_ --r-.______:Ma er'al___. _____- p��- r � �+ l _ Disposal Distance.from��nearest well�_.'_'r�_...._D stan� from foundation--/found. Liquid dl pth_____ _________________�_-Capacity_=,�C_7U--- -.--- No of compartments._.._.__ ation__/®_.____...__.Distance to nearest of line Number of lines__ __-__-Length of each line_ _' 0._7ET _---._.Width of trench': _____________________ Type.of_fil•ter---maternal- .�J . ___.__.Depth,rof fI+.er_rna r.ial "---_______._.,Total length___-_.. ---------------------------- Seepage _______________-________ l pig—� p g 1 ............Distance to nearest lot line_'_.._._._ See a e Pit: * Disi�an�e to near`st well------ Distance from fa dation___..meter__.�t,�.. _ -Depth------._��. ,_�___.__.______ Number_of its----c.:_._..___.______Linsn a e`na__-- C- --':Size:-Dia Cesspool: Distance from nearest well_________________DiAance from found-ation�___-------------------.Lining material__-.__-...__--..____._ ❑ Size: Diameter -� - Depth 1 J, ---------k------- Liquid Capacity------------------------ gals. , Privy: +''Distance from nearest well_____________________________________________ Distance from nearest building__ --------------------------------------- It __:____- _--____________.___.____ ❑ .� , (\\. �l)istance to'nearest'lotyline-.__= _.:_, r tt---------------------- ---- - - ------------------------------------------------------------- Remodeling and/or repairing (describe)----------- --------------------------------------- ` -- ------------------------------------------------------------- = ----------------------------------------- = = 1 3 I ---------------------------------------------------- -------------------------- _,_--- -------- 1, I hereby certify that I have prepared this appli tion_and+hat the o k will be done in accordance with San Joaquin County ! ordinances, State laws, and rules and regula o s the S n Joaquin Local Health District. {Signed]^ ___�.,...---------._•�.�.__ �,�� . �— - �- - (Owner and/or Contractor) t p: By:-------------------•--•-----...-•- -------- - ---------------------- ------------------------- =.•------------------�----(Title]---------------------- -- - -------- - - - -.._,--------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed.on reverse side): FOR DEPARTMENT USE ONLY k APPLICATION ACCEPTED BY--- =�- ----- ----------------------- ------- ---- -------------- ------ DATE-------------�1 _Q6 REVIEWEDBY -------- ------ ------------------------------------------ DATE--------------------------` BUILDINGPERMIT ISSUED------------------------ --------- --------------------------•--------------------------------------- DATE--------------------------- -------- Alterations and/or recommendations -------------------- ----_.__ _ - _ 1 __________________________ __ .___ ---------------------- - - --•-- ---- -----�` --- ---~ L-- --------- --- -------�' "-- ---- ---- --- ......---'-- ------------------------------• ---- '-------------------------- i "---- - ----------- ------- ------ ----------------------------------- FINAL INSPECTION BY:..----� �' ------- Date- .-... ---- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT ! 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVI5ED 5-59 3M 3-'63 F.P.CD.