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FOR OFFICE USE: _— -------------------------------- ---- - ---------- APPLICATION FOR SANITATION PERMIT Permit No. ._. �-' � (Complete in Duplicate) / 4 CtD ) Date Issued ___ _.1_d_/____ _ly , -----______------------------------------------------------ i This Permit E Aires ll 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 County Ordinance No. 549. D,o -7-- 2-50-,e JOB ADDRESS AND LOCATION n- y � �v ,... -Aw......ei_ �-'�-s- -�>: Owner's Name- 1.l�,Gt t- 'P�4P: >� .�a -c' .:_.��:._I� Phone.----.__.... == ----------- --------------- Address--r -- _ Contractors Name----- , ---------- ------------------------------- Phone------------•-•---•------•----•---• . I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ __ Number of bedrooms __Number of baths __. -_ Lot size ___ `_ -----f�_�______.__ --------------- Water Supply: Public system.,❑ Community system ❑ . Private:R5/Depth to Water Table ________ ft. I Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam [-] Clay Loam ❑ Clay obe ❑ Hardpan [] - Previous ardpan ❑Previous Application Made: (If yes,date-----------_--------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted..if public sewer-is available within 200 feet.) Septic/ank: Distance from nearest wek_,-6�P----- Distance from foundation__-14__�______-Material------- • •�� a ----------- No..of compartments----_-. -- Siz}_ _ _ _`.`_:S'.PLiquid depth----4/_'______________C apacity._. A'_ =- . Dispos ield: Distance from nearest well---.-.-..L---_:-'Dis#,ante from�fbutidation___1__/t._-_____..Distance to nearest lot line_ __ .�___ + r Number of lines____ - - S Length o"each line _ '�. '_� S"r.Width of trench_____ __ ----------_______- (N Type.of #filter,matenak�_.-4t_X______=Depth.of filter.ma#erial ----/S_____________Total length-------- :______________________ � f Seepag�Pit: Distance to nearest ------Distance fr rrm.foundation_____If?_______ Distance to nearest lot line___ `__.___._ n F?l Number of pits------- e: Diameter------____..____Depth__.__.��_---____________.__ - fl Cesspool: Distance from nearest well------------------Distance from foundation____,_______.__:_.Lining material------------------------------------- 1 Size: Diameter-------- -------------------------D1-k th_,=;._----------.-- ` - -----------Li uid Ca acit ---.---- als, Privy: - Distance from-nearest well-________________________ _____'�4k----__...._Distance from nearest building-------------------------_-__--.-.-.__-_.- ❑ Distance to nearest'lot line-----------------`.--.`�----------------- r ] ------------------------------------------------------------------------ - ---- -- Remodeling and/or repairing {describe):----------------- � =_ _'`' _ ------1-.--_r------T------------------------- ------------ -------------------------------------------------- I ------------•--•-••-------------------------------------------------------•----------- ------------------------ ----------- -------------------------------------------------------------------------------------------- ----------------------------=----•---------------------- --------------------- ------------------------------ -- ------. -----• ------------------------------------------------------------------ ---- ------------------------------------ --------------------------------------------------- -•-------I------------ j___. I hereby certify-that,l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, States, and rules and regulations of the San Joaquin Local Health Disfrict. [Signed]------ -------`- •---- -}'�` ---------- - - ----`-----. ----------------- (Drwner and/or Contractosl ' r BY - _5 �_- ----•---------------(Title)----------------- --�---�--------:-.:'.:`--�.----- �.. ,> (Plot plan, showing size of lot, location of system in relaAn to wells,.buildings, etc.,.can be placed on reverse side). 4r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = ------------ DATE------ - --------- REViEWEDBY = --------------- --------------------------------------------------------------- DATE---------------------- BUILDING PERMIT ISSUED--------------- I------------------------------------------•----- ---------------------------------- DATE-- ---- Alterations and/or recommendations:x ---- ----------- --------•--------------•--------------------------------_-----------•---------•-------------------------- t -•-----•--------•-------------•---------------------------------------------------- -------- =------- -----------------------------------------------------•--••------••---•--------------------------- ---- - ------E- -•----- ----••---------------------------------------------------•-- -� --------------- -------- ------ ---------•------------- -------------------------------------------------------------- ------------------------------------------------------------------------------------------------- --------------- -------- a------------------------------------------------------------------------------------------------- - ------------ --------------------- ---- - ------ - --_----------------------------- F ----------- FINAL INSPECTION BY:_ ------------------ ------------ Date © �6 -- - ---- - ------ - -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Cs 9 REVISED 8-59 3M 3-'63 F.P.CO.