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FOR OFFICE USE: -- ------ - ------------------------------ --- ---------- ------ ----------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit NO. ------------- --- ----------------------------------- ------ (Complete in Duplicate) ------------------ --------------------------1�------ This Permit Expires I Year From Date Issued -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 AN D-t-0 CATION -- ------ -------- ------- Owner's Nam ------ ---- ----------------------- -- ---------------------------------------- Phone------------------------------------- 1? Address----------------- - ...1. "1 1 -----------jo--------------------------------------------------------------------------------------------------------------------------------- Contractor's Name------------ I'le ft- /----------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence,IJ�Apartment House. Ef Commercial E] Trailer Court Ej Motel 0 Other 0 Number of living units-. _/--- Number of bedrooms g_!_ Number of baths Lot size ------------------ Water Supply. Public system C] Community system ❑ Private "'th to Water Tablegl;rw- N Character of soil to a depth of 3 feet. Sand E] Gravel E] Sandy Loam C] Clay Loam Clay [] Adobe 0 Hardpan El Previous Application Made: (if yes,date--------------------f No �New Construction: Yes E] No ffr"_FHA/VA: Yes 0 No�� q TYPE OF INSTALLATION AND SPECIFICATIONS:' (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:r- Distance from nearest well-----------------Distance from foundation_-.------__-_---._.Material_-_.________-____-...._..__..___.__._..__-____. o:. of compartmenfs-------------------------Size* -- -------------------------------Liquid depth----------__ --------Capacity----------------------- DisposaP Fiel�: Distance from nearest well______..-_-..-"; D,1,06nce from foundeition-------------------_Distance to nearest lot line--------- v Number of lines-- ------------------------------Length of,each line----------------------------Width of french----------------------- Type of filter material-------------------------Depth of.filfer material-----------------------Total length-------.•----------------•----------------- I s it: ength--------I---------------- it: Distance to nearest.well_ Alr Msfante fr oln foundafion__,_&9 Distancelo nearest lot line--.,--—------- Number of pits.... Y-------------Lining maferia Size: Diarneter-,W.cViAeepfh-,-O�-----/', _--__-_---. Cesspool: Distance from nearest weft-----------------Distance from 'foundation--------------------Lining materia!____.--__----------_---_-_._-_-_-_. ❑ -------------------------- -------------------- -------------------- :gals, Size: Diameter--._-2-" ---- Depth------------------- ---- ----Liquid Capacity -Disfance-from nearest well_____ ------- -------------------------- _Distance rc,4�,ea`res� ��iTing El Distance to nearest lot line------------------- " - ---- - -- --- -- --------------------------------------- --------------------- ------------------ -------- Remodeling and/or repairing (describ -------- -------------------------------------------------------------------- ----------------------I------------------------------------------ ------------------------- ------------------ ------------------------------------------------------- -------------------------------------------------- 17i177-----------------------------------------------------------------------------------------------:--------------------------------------------------- ----------------------------------------------I——------------f 7 ---------------------------------------------------------------------------------- ------------------ ---------------------------------- 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 andiiegulations of the San Joaquin Local Health District. 0011 (Signed) ----- ---------------------- .. - -- -------- -- ------- - ---- ------------------------------qQwnw=andj-&P.Contract or), � ---------------- By:---------------------------------------------- ------------ ---------- ---------------I-----------(Title). .................. .. ...... II (Plot plan, showing size of lot, location of.,sys, in relation�fo wells, buildings, etc-can be placed on reverse side). OR DEPARTMENT USE ONLY 77- APPLICATION ACCEPTED BY- ----- - _Y ------------------------------------------------------------------- DATE-----AP A30- REVIEWEDBY------------------------ -------- ------------------------------------------- ------------------------------------------._ DATE BUILDING PERMIT ISSUED- - --------------------------------- -----------------------------=--- --------------- --------- DATE----------------------'---'-------------------------------- -- Alterations and/or recommendations:_------------:-------------------- -----------------------------• -•-------------------------------------------- ----------------------------------11--------------------------------------------- ------------ ---------------------- ---------------------------------------------- ------------------------------------ ----------------------- ----------------------------I-------------- ----------------------------------------------------- i - ------------- - ------•-----------------• - ---------------------------------- ------------------------------------------------------ ------ tt-'r--------- ------- ----------------------- -- --------------------------------------------- ------------------- --- -------- ---------------------------------------------------------------I--------- --------- - Ip 91t ------------------------ ----------- ------ ------------- ------------------ -- - FINAL INSPECTIC ------------ --------- Date--------------- ------- SA ------------------------ AQUIN,LOCAL HEALTH DISTRICT 1601 E.Ho on Ave. 300 West Oak Street 124 il Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3"43 F.P.120.