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�. FOR OFFICE USE: y �� ------------------- a�_'.V J APPLICATION FOR SANITATION PERMIT Permit No. - ----------------------------------------------------- -- ----------------------------------------------I (Complete in Duplicate) Date Issued ____13A-51 _________________________________.._.__.._.___.-I-_ 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. JOB ADDRESS AND LOC N Ile 0/ ----- �"' -----------------`------------------------------------•---------_----------------------•--------------- Owner's Name ------------- --- ----- - Phone------------------------------------ ------------- -•----- ------------------------------------------------------ -------------------- yf -------------- -------------------•----------•-----------------•-.-----Address "� e Contractor's Name____ 1 p ------------------------------------------------------ Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercials❑• Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ -- Number of bedrooms .Z._ Number of baths __/__ Lot size __ __________________________ Water Supply: Public system y y ❑ ❑ p 6O`4 [1�Gommunit system Private Depth to Water Table4O-4. t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ + Clay ❑ Adobe I-W-Pardpan ❑ Previous Application Made: {lf yes,date-----------_--------I No @-- New Construction: Yes ❑ No_®-- FHANA: Yes ❑ No e-- TYPE OF INSTALLATION AND SPECIFICATIONS: --il (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank Distance from nearest well-----------------Distance from foundation--------------------Material---.__-____.__________._____________.____.__.._. I��/y No. of compartments-------- -----------------Size--------•------•----------------Liquid depth--------------------------Capacity----------------------- tm�( Disposal-Field: Distance from nearest well.... '_.__Distance from foundation____ ___._.Distance' to nearest lot ______ Arte ] v'�% Number of lines-_-•.------ ---_'_- Length of each line---A0-----------------Width of trench.__ ---.--------------------- /------ -- �- Typet f filter materlal.4 Depth of filter material---fr______--_Total. length-----ko—e......_------------__------ Seepa P►t: Distance to nearest well....'.--_._______Distance fr fou dation------Akp...__.Distance to nearest lot __- _ /iDepth-A24`� Number of pits_____ __________;__Lining mate .__._.__.Size: Diameter �•__._--- R'_____________.______ C s p-ooT: Distance from nearest well-----------------Distance from foundation------ --------- ---:Luning material------------------._________________ O ❑ Size: Diameter-------------------------------------Depth-----------------.---------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest wef-------------------------------------------------- from nearest building--------------.______________.._____._._. ❑ Distance to nearest lot line-------------------------------- Remodeling and/or repairing (describe)---------- --------L��r�� _ 10 .r • - - -------------- ----------•--------------------------------------------- 0 - uei'=_'-.-.- -----L.�- -----------------------------------•------------ --------- ---------------------------------•------------------------------------ ------------------------------------------------------------------ ---------------- -----------------------------------------•-----------------------------------•------------------------------- ----------------------------- -----------------------•----------------------------•---------- ------------------------------=---------------------------------------------------------------------------------------------------------•---------------------------------------------------------------- ------------ 1 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 a d regulations of the San Joaquin Local Health District. (Signed)------------------------ ��---- (�r Contractor WZ By:------------------------------------------------------------------- ------ ---- -----^- "---------------- ..- -------------- (Plot plan, showing size of lot, location of system in relon to wells, buildings, etc.,-can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY -------- �- 7-7— DATE ------ REVIEWEDBY--------------------------------------------------------------------------------------------------------- ---------%---------- DATE----- •---------- -- BUILDINGPERMIT ISSUED--------•-•-------------------------------------------------------------------------- - DATE-•------------•---------- Altera+'ons and/or recommendations:----- - ------------------------ -----------•------------------------•--•--•------------------------------------------------------------------------ I -------- Q ----- � �--------------------- ------------------------------------ --------------- ---- ------------------------------------------- ------------------- -- -------------------------------------- ---------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ -------------------- ------------------------------ I FINAL INSPECTION BY:- ---- �C2_e-- ------- Date-------- `�- - ----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT'S3 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Mantecar California Tracy,California ES 9 REVISED 6-59 3M 3—'68 F.P.Cq.