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FOR OFFICE USE: ------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ____/_. 1._y...._-- ----------------------- ------------------------ (Complete in Duplicate) Date Issued __15�1�_�� --------------------------------------------- ------------ ` 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 County Ordinance No. 549. _ 060 .—f o 7/.6 . /o ;r_y JOB ADDRESS AN LOCATION,-�"ll1---- -- ------- ---_ _t--- ---------- -- --�--— - -- ------4p�' - '_ Owner's Nam ---- �rL �-g d - G--- •- ----- one------------------------------------- Address--- Contractor' • . , Address /. --• �f1��-- --•----------------------••- ----- __ _________________ _ - .. A s t Contractor's Name____.` J ------ a ...--- --- _-. �L!1�' t �rtJ. Phone------------------------------------ Installation =Installation will serve: #Residence ur_'�Apartme t House ❑ Commercial ❑ Trailer. Court ❑ Motel [] Other ❑ r Number of:living,units: __-/___ Number of bedrooms ____ Number of baths _ ` Lot.size ____ -- _ ________________________________ Water Supply: 'Public syste'❑ Community system ❑ Private Depth to Water Table`7_77'ft:- Character of soil to a depth of 3 feet: : Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ 7 Previous Application Made:-•(If yes,date--------------------) No E] New Construction: Yes ❑ No ❑ FHA/VA: Yes El No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: P (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septi ank: Distance`from nearest well___ C�_____Dlstair e from foundation___-.A0-_-_____.Material___t Q �. ---,_______________________ No.-of coni artments_-_-_- __Size. 1Z � l_i uid de th_--___ Capacity./ Dispos Field: Distance from nearest well-.,;IF0-__-_Distance from foundation---1-,7_ ___ -.Distance to nearest lot liner______-_---- Ndmber of lines------ _�_. Length of each line-_--'Y'fO......._ __ -------Width of trench-_- -------- ___ Type of,filter material_ lrL_�_____-__Depth of,filter rraterlal___-___!G__P_____-_Total- length-__-�=/__------.--------------------- Seepage Pit: Distance to nearest well__________'_________Distance from foundation-__...._.-•._-_-___.Distance to nearest lot line---_-----_-_---,---� I El P Nmber of Its # ` Lining material----------------- --Size: Diameter.- Depth - Cesspool: Distance from nearest we#I-----------------Distance from foundation--------------------Lining material----------------_--------------------- IN`F Size: Diameter---- -------------------- -----De.th--------- - ---------------------------------------Liquid Capacity -------- als.3::r Privy: - Distance-from.n'earest well--------------------------_--------_--------------Distance from •nearest,building-------------------------------- -- - fl ---- -7 ❑ Distance to nearest lot line-------------------------------------- ------ -------- ---------------------------------------------------------------•------------------� RemodeSing and/or repairing (describe):-------------------------------------------------------- -------- -------------------• •--------------------------------------------------------------0'":.• t t it---- A I hereby certify that I have prepared this application and that the work will be done'in accordance with San Joaquin County ' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. , (Signed)------------------------t--- �; - r and/or Contractor) 9 B ' (Title)---------------------- ------- ...... _- - Y•-------------------- 4 (Plot plan., showing size of-lot, location,.of system in relation to a s,.buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - - -------- - ----------------- APPLICATION ACCEQ_BYDATE ------ REVIEWEDBY -------------------------=---------------- -------------------- DATE--------------------------------------------------------- BUILDING PERMIT ISSUED ----= -----------=-- ----------------------- DATE--------------------------------- Alterationsand/or recommendations:---:---------------------------------------------------------------- -•--------------------------------•-----•--------- •---------- ------------------------------- ---------------------------------=----------------------------------------------•-------•--------------------------- -----------•-------------------------------••--•---------------------- ----------------------------------------------------------------------- ------------ ------------------------------------------------------------------------------------------------------------------------ --- -------- ----------------------I------- -----------------------------'---------- ----------- --------------------------------------------------------------------------------------------------------•-- ----•---------- -------- ------------ -----------------•-------- s 1 L FINAL INSPECTION BY_ _�X -------------------------- ------ - -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1501 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ' � I Stockton,California Lodi,California FS Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3•'63 F.P.CD.