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�h do OFFICE USE: 6_-�------ -------�------- - / --------------------- ------------------- ------------ APPLICATION FOR SANITATION PERMIT Permit No. _1_7 ► ---- -------------------- ------------------------------- (Complete in Duplicate) / 'J This Permit Expires 1 Year From Date Issued Date Issued ---A/ -231 J Application is hereby made to the San Joaquin Local Heal}h District for a permit to construct and install the work herein described. - This application is made in compliance with County Ordinan "549. O� f _3iP JOB ADDRESS A _D LOCATIONrt -_--- oZ e , G_- � .3�------------------------ Owner's Name •-- #= -- • --- -- ---- - Phone-- 7__ - �� , % Address 2'.5 .t� tlkl yYf ��'. `��,� �- /-e L'J f ------------------ ----- --•-•-- Contractor's Name---------- ______ -. .---_-.___ Phone._��__-, � - Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] Motel ElOthe I—]Number of living units:/----- Number of bedrooms _ _ Number of baths C;2- Lot size __ �y ElE] 3_ ----•------- Water Supply: Public system Community system Private Depth to Water Table a ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayAdobe'❑ Hardpan ❑ Previous Application Made: [If yes,date--------------------) No ❑ New Construction: Yesk. No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 0,'�,,Noseptic tank or cesspool permitted if public ;ewer is available within 200 feet.] f" 1 +k: Distance from nearest well-_%5 ------Distance from foundation/,6---------.Mater' No. of compartments..�-----------------$ize__ 5�-_ -------Liquid depth-_�......--- -----Capacity - 6Q-- -- i al Field: Distance from nearest well_---------- ------ to nearest lot line__________._____. vl Number of lines------------------------- - '--Length of each line------ ---------------------- of tench.._._..----------------- -- Type of filter material-------------- of filter material________-_---'___.._Total length------------------------------------------a e� a it: Distance to nearest well______________________Distance from foundation_._-----__........_.Distance to nearest loft line-__--__-___-_...- Number of pits--- ------------�--__Lining material----------------------- Diameter---- ------Depth-------------------------- -. -- p� . Cesspool: Distance from nearest well-___---____..__Distance from foundation____________________Lining material-------------------------------------{ ❑ Size: Diameter--- I--------- - --------------- :Depth----------------------------- p------ __�____..-LiquidY Ca acit ----gals. 1 t � Privy: Distance from nearest:well___----------------- ------------------------------- Distance from nearest building4I ❑ Distance to nearest lot line.-, ------------ 4 RemodeUng and/or repairing (descr6e):----- - i --------- ----------------- ----------------- ------------------------------------------------------ -------Il ,.. �- ----- ---------------------- ----------------------------------------------- ----------------------------------------------------- - - i �, , -------------------------------------------•-----------------•-------------- I here ertify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinanc s, S+ a laws, ander ies and,regulations of +he San Joaquin Local Health Distric+. (Signed) -- Br• - --- --------- ---1-- --- -- ----------------------- ------------------ wrier and/or Contractor) - -------------------------- - -- -----44 ---- ---------------------•--------------------- (Title)-- ----- ------------------------- ------ - (Plot plan, showing size of lot, location of system in relati� o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --_ .. _ ��f""'� -- DATE r��` - ----------------------------------- REVIEWED BY---------------------------------------� ± -- ---------------------- -------------------- ------------------ ------------------ DATE------------- ---------- --- -------- BUILDING PERMIT ISSUED---------_-------- Alterations and/or recommendations:------------------------------------- ---------------------- ---------------------------------- ------------------------------------------- -------•---------- -------------------------•--•---------------- 1 t --------------------------------------- -- ----- -------------- '------- ----- - ----------------------------- FINAL INSPECTIONBY:_._.--- v� --•---M1----- -- - L_ Date-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. "'° 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr California Lodi,California Manteca,California Tracy,California j ES 9 REVISED 8-59 3M 3•'63 F.P.CD. \