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FOR OFFICE USE: Ilia ------------ --------------------------------------------------------------------------- - Application is hereby made to the This application is made in complia JOB ADDRESS Owner's Name -- Address ------------ Contractor's Ne z9i.o APPLICATION FOR SANITATION PERMIT Permit No..' -I— q � 0 (Complete in Duplicate) Date Issued ____- 'This Permit Ex fres 1 Year -From Date Issued Joaquin Local Health District for a permit to construct and install the work herein described. with County Ordinance No. 549. n A i n - ------ --- me..---• ....... --- ne__ Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _. Number of bedrooms Number of baths05-_�r Lot -size -. - -- ------------------------------------------ J Water Supply: Public system 0 Community system �ivate ❑ Depth to Water Table _0�t. Character of soil to a depth of 3 feet` Sand E] Gravel E3 Sandy Loam E] Clay Loam E) Clay [3 Adobe Hardpan [I Previous Application Made: (If yes, date ----------------- ._.) No Ejo�ew Construction: Yes El'�No ❑ FHA/VA: Yes R�'Flo ❑ r f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) Septic Ta p4 Distance from nearest 'Al ___�'""___ Distanc � from �pundati, n ---Ie �___(�_(r f /______________ No'. of compartments_ _ ---- Size ,j a� _Liquid depth----- _- Capacity..4GQW_____- Disposal Field: Distance from nearest well ------ -----_ Distance from foundation._Z.41 ........ Distance to nearest lot ine-__►>'�_____ Lam'9K— Number of lines___:_��_____ ____. Length of each line--- Width of trench.-_ _ - g �---------------- --• ----------------- - ------------------- Type -- -------- •--- Type of:filter material,4 Depth of filter material__/��, _____.Total length__ Seepage Distance to nearest well ------- a""_.__.__Distance mfou dation_lp..._..Distance to nearest lot line --NO ___ Number of pits ------- �---------- Lining material. _ -.P_ ,+.Size:__Diameter__....... Depth__a'/ Cesspool: Distance from nearest well ------------ ----- Distance from foundation ------------------- .Lining material__._____.---_______.______.___-.__---. ❑ Size: Diameter ------ I ------------------------------- Depth_-------------------------------------------------- Liquid Capacity- ------ ._...------------- gals. - ---------------------- Privy.. crest well_______________._..______________.__.______.:_Distance from nearest buildingr_______________... Priv Distance from nearest e r ., .r ❑ Distance to nearest lot. Ione- = - 4 6 ----------- ------------------- Remodeling and/or repairing (describe ).------. _------ ---------------------- 4-� .--------- ----•---------- 3 _ t, ordinances, certify awth4andrualesaIhaverep r uthis ap lli ate n an - h h -- o will •- - -- in - c r -- - -- Sa - ui n --- - - -------------ate n and'that the work will be done in accordance with San Joaquin County g San .Joaquin Local Health District. (Signed) --------------------------f c- --------- {C-cler_-and/or Contractor) By:--------••-------•-••--=--------------------i-----------=------------------I--------••-=------(Title) ---�-- zm. ------ (Plot plan, showing size' of lot, location of system in ret n to we Is, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- --- - ----=-=-•---------------- DATE., -!V_._= `�� k_1 ----- REVIEWED BY'-=------------------------------------------------------------------------------------------ •--•---------- DATE---------------------I--------------------- ----------------- BUILDING PERMIT ISSUED--- --- .-------------------------------'-------------'-------- --------------- `> DATE ----------------------4------- -------- ---------------- Alterations and/or recommendations: _ s =------------- --------------- --••----------------------------- =- ------------------------- -------------- --- �=- -- / - ` ��-=-------------------------- = -- --•-------------- ----------- ---------------------------------------------------------------------------------- - - - - ---------- - - - - ------------ - - - - ----- - - - - -- - ----------------------- - - - - ------------ •-•-------------------- - - - - ------- - - - - -- FINAL INSPECTION Date------ y- ---- - ----- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West Stir Street Stockton, California Lodi, California Manteca, California Tracy, California #E8.9 RMSED 8-59 F.P.0 O. 2M 6•60 b