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f OR QFFICE USE: f ---------------_ -__. APPLICATION FOR SANITATION PERMIT Permit Nor. ------------------------- --- ---------------------- (Complete in Duplicate) 7i xx Date Issued ----------------_---_---_-------------------------------- 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 Ie. County Ordinance No. 549. JOB ADDRESS AN C TION____l..;l-_d� + ----- •-- Owner's Name-- ! � � --- -------------- Phone-•---•----------------------------------------------------- Z---------- ---------- ----,---a ' ' � --------- ----- -- ---------- ------------------------ Contractor's Name fi' -------- -- ------- --------. Phone--------. ----...------••---•-• -- -- - ------------------------------------------ r Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____ Number of bedrooms _ _ Number of baths __/_ Lot size __-s-1 '�__1sZ_5_ _________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table rQ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ` Hardpan ❑ Previous Application Made: ilf yes,dote__-?�57-7..__., No ❑ New Construction: Yes ❑ NOA FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) k: Distance from nearest we1L________________Distance from foundation--------------------Material--------------------------------------,-________- ❑ No. of compartments-- ------------ ----------Size----•---------------------------Liquid depth--------------------------Capacity----------------------- Id: Distance from nearest wellAOW Distance from foundation-__v2.4........Distance to nearest lot line,___47.1._____ Number of lines------ ---Length of each line------c2�._.b___-----------Width of trench____7_J�__/ ------------ Type of filter ___Depth of filter material___/, el-------Total length-----------------_-----45-----_-------- L6 �i#: Distance to nearest well*0/0V '___Distanc0 m foundation--- �.______.Distance to nearest lot line_________________ Q, Number of its._..__ Linin material. + C,l�-__---Size:'Diameter_. _ -C..........Depth_- Cesspool: DJ stance from nearest well------------------Distance from foundation--------------------Lining material-_----------____-...--------_-._---.- ❑ Size: Diameter--------------------------------------Depth------------------------------- --------------------Liquid. Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- 0 Distance to nearest lot line ------------- -------- ------- ---------------------------------------------------------------------------------------------- .. I Remodeling and/or repairing {describe):--------- ---------------------------------------------------------------•----•-----------------•-------------•----------------------------------------- ------ ----- -- - --------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------•----- 1 hereby rti that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to aws, and rules and regulations of the San Joaquin Local Health District. -r (Signed)----__ -- _ -- (Owner and/or Contractor) y --- ----------(Title) -- �------------•----------- (Plot plan, showing size of lot, location of system to relation to ells, buildings, etc., can be placed on reverse side). Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ----_---- --- ---__ DATE---- - _-- � - - ------------------------------------------------- ---------------------------- REVIEWEDBY--------------------------------------------- - --------------------- ------- -------- ----------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------------------------------------- ------------- ` Alterations and/or recommendations:--------- , -7"_„<Uri- _4- :c "' ---- % — .----- - --•�`= '---------------------- -------------------- --- ----------------------------------------------------------------- -------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 7 ------------------------------ FINAL INSPECTION BY: . ._.._ ._ _...__ Date--. -- ---------------- --- = SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 9-59 3M 3-'63 F.P.Ca.