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FOR OFFICE USE: - ------- --- ��¢{-- -- ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _-.. ..�y This Permit Expires 1 Year Froin Date Issued - r Application is hereby made to the San Joaquin Local Health District for permit to const uct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION ---------______N_- ----'--------______�� Owner's Name----- - _ ----------- Phone_4041_._s_z!!F�7---- Address-------------------------- ---Address-------------------------- ---------------------- z 1 ---- •-----------•-- ------------- •------- ----- Contractor's Name---------- ls_ ------ - ------------ Phone..W .'�jz0,,1______ Installation will serve: Re1sidence Apartment House [3 Commercial ❑ Trailer Court ❑ Motel E] Other ❑ 4 : � r Number of living units: __ ____ Number of bedrooms .1--- Number of baths ______ Lot size_► ___ ------------------------- Water-.Supply: Public system F] Community system ❑ Private Depth.to Water Fable 12P ft. , Character of sail to.a depth of 3 feet:�Sand ❑ Gravel ❑ Sandy Loam 0,,Clay Loam ❑ Clay ❑'Adobe Hardpan ❑ Previous Application Made;k, yes,--- -__ ,.______) No New Construction:*Yes "No FHA/VA: Yes ❑ No� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---- _�__Distance from foun'dation____Q_0_`____.Materi ------------------------------------.------------ No. ____.__._.No. of compartments---___-T--------------- ------Liquid depth------ r _Capacity---kO^ _ .L Disposal Field: Distance from nearest well 5T-----Distance from foundation.__'!�_C)F____.Distance to nearest lot line---1,rX.--`.! Number of lines---------------- -------Length of each line---------- of trench__------ --____-- p w _ p 9 C_( erial--------/�-------Total .length--- --- - ---------- Seepage --------- S' See a e Pit: Distance striwel-MO.______D stance frotmrfound pt - Y € I YP - ---- __ �� Distance to nearest lot IV Number of pits------_/.-----------Lining mate rial-_0-AZZ74".Size. Diameter_______ _'___Depth_.__. 7______________ S . t Cespool: Distance from nearest well------------------Distance from foundation---------------------Lining materia!_--_...__________.__._____-_______. [❑ Size: Diameter----------------------------------- Depth----------------I----------------------,---------Liquid Capac: ----------------------..gals. Privy. ------------- ------"._Distance from nearesf_ uilding-�-----_----------___ y Priv Distance from nearest weH_______________________ ______,_________- --�. - F1Distance to nearest lot line------------------------------- f ' ` - .�+ Remodeling and/or repairing (describ' :-.__-/ _ "-_--- -� __.__:_ "��/� _ :•. irs* t1 _ ii-----------•-------.-- { i _______________ ______ .� i f �+� ____________________________________________________________ ______.____._____________ ______________..___ _______.______________________-________----_.__ L E { r 0 -------• Ii ). I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun+y ordinances, State laws, and rules and reguiations,of the,San,Joaquin Local Health District. [t 'X (Signed) -- -. '' . ' -------------------------------------------- = -- _._, (Own rand/..or Contactor By=--------- ---Kcaflon� --�-"A4-------- ------------------------------------ -------(Title)---------- _ ' -------------------- ----------- (Plot plan, showing size.of lot, of ystem in relation to wells, buildings, etc., can be placed on reverse side), e r - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED /BY------------- ---------- - ------ ------------------------------------ DATE--------- REVIEWEDBY------------I-------t------------------------------- - ---------------- ---------------------------------------- DATE-------------------------------------------------------- --- BUILDING PERMIT ISSUED------------- ------------------- - - aATE___________________-_- . ----------- - ------ ------------------------------ Alterations and/or recommerlda+ions:...__.. .__/_ /i.7________________ ___- = ------•--•------------------------------------------------------------------------------------ - ------------ -�---.r-i__ -_._- _�C__� �-::-- °- � ----------- ---------- f < I€ ------------------------------------'------- ----------------- ------------------------•------------------------------- -----------'------- - --------------------------------------------- ----- F€NAL INSPECTION BY:.. -- - - -------- ------ ------------- S N JOAQUIN LOCAL HEALTH DISTRICT �. _p 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street K Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVI SEP 9-58 3M F.p.CC.