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FOR OFFICE USE: ------------------1-3-0 ---------- APPLICATION FOR SANITATION PERMIT Permit No. ------ --------------------44. ........... (Complete in Duplicate) Date Issued ... . ............... This Permit -- ------------- Expires I Year From Date Issued Application is hereby made 4o the San Joaquin Local Healfh,District.'for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance;No. 549. V-4#W4 JOB ADDRESS' AND LOCATION----- -V- ---- ---- ------------ W Owner's Name--------- ... ....... -----------------------------5---------------------- ------------- Pon p--- ............ 3 A 10 1.= 46h ._t_ J�fO Address------------I. ................. . ..I . ...... __M ............. --- -------- --------- •--- ----- -- ------------------------------- Name--,-- ---------------------------------------------------------- Phone---1-1-A-04-7-5-L. ----- ----- Installation will serve: Residence,[Q' -Apartment House Commercial ❑E] Trailer Court ❑0] ef-0 0TRe Number of living units: --- ... Numlb�ar of bedrooms .'"-J--- Number of baths --- Lot;size ------------------------ _il�-----------I-------------------- - Com' munity system E] ,private [-] Depth to Water Table ------ - Wate' Supply: Public,system P� Character of soil to a depth of 3 feet ISand ❑ Gravel Sandy Loam E] Clay Loam [I Cl y 01. Adobe Ig Hardp&n F] - Previous Application Made: (If yes., cite {� New Construction: Yes W Noo FHA/VX Yes E]., No TYPE OF INSTALLATION AND SP CIFICATIONS--.— (No septic tank or cesspool p firnifted if public-sewer is available within 200 feet.) Septic Tank: Distance from ne rest weh---1V!;k!!_r_Distance from foundation-----1-q---------Material'---------------------------------- 9 No. of compartments------ Liquid depth------Lf---------------Capacity---FAQ Disposal Field: Distance from nearest well__A&0tv__CDistance from foundation____I 2Pt----:-----Distance to nearest lot line-T- __1--------- Number of lines------�L-----------------1-n----Length of each line----1--------/a____--.Width Width of trench.----:L------------------------- Type offilfer materiaL-ko--c-A__-----D e pth-of-fiIter-ru,ate ri a I------�_r-----------Total -length----------1_4�............__-t_________ page Pit: Distance to nearest:well---I V_q_??_.'_f__Distance from-f6tinclaf ion-----J_Q-------Distance to nearest lot line__S-,_'* u) ----- N .rnber of pits------4n------------Lining mate Sizie: Diameter____- --------Depflh__O�JJ................ c ------------ cesspool: Distance from nearest well-----------------Distan e from foundation...------------------Lining materia--------------------------- ffSize: Diameter--------------------------------------De pt h------------------t----------------------------------Liquid Capacity---.--------------------I gals. • Privy;! Dis'fance from nearest weil-------------- ---- ------------------------------Distance from -nearest building-------------------------------I--------- D'ffanc&,1P nearest lot line---------------------------- -----------------------------------I------- ------------------------------i--------------------------------------- r - a - - I j ❑ or ...... -- ---------- -- ------- elin�nd(// a p4api I nlg�7{describe):c r i b e): =- - ------- -----ezt------A-P. - -------------------- - ---------- ----- ---- - ------------------ --- ------------ I----------- 3, ---------- ---------------------- ---------- --------------------- ----- --------------------- (7� --------------------- ------------------------------ .......... ---- - -------- T.-.17-L-- - -- ----- ------------------------- -------------- 7 I hereby certify that I have prepay this application and that the work will be done in accordance with San Joaquin County ordinances, State laws' and rules and ieg6lzilions of the-San Joaquin Locial Health District. -------------- ---------- - -- ------ ---------- -------C-------------------------------------------------------------- ------------------------(Owner and Contractor) By:---- - -----------=---------------------------- ----- -----------------r------------------------------------------------------(Title)-----------------------------------j------------------------ (Plot -----------t---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- -------------------------------------------------------- DATE----- T-.= �'r -------- '--------- REVIEWED BY--------------------------------------------- ---------- - ------------------------------------------------------------------- DATE------------' - ------------------------------------- BUILDINGPERMIT ISSUED----- ------------------------------------------------------ --------------------- DATE------------------------------ -------------------=-------- -------------- .-. and/or rec e d t" ------ -------- --------------------------------------------------- ---- -------- .. .......... -------------------------- ----- ------------- ---- ------- rlWrl I ----------------------------------------er - ----------------------------------------- - ---------- ---------------------- --- ;;:;� d�__z --- ----.e- -—----------------;4------ ----------------------------------------------------- - --- ---------- -------------- --- ---- ---------- __ ___ W --------------------------------------------------------------- e---------- -------------------------- - ------------------- -------------- - FINAL INSPECTION B;y_:__jL------ --------------- Date-------- - ---------. ------------- L SAN JOAQUIN LOCAL HEALTH DISTRICT 4 1601 E.Hazelton Ave. 300 West Oak Street S.,:- 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVI5ED.8-S9 MM 3-'40 F.P.12P.