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FOR OFFICE USE: ----------------------------- --------------------------- ---- ------------------------ e=J, // ,{ ----. APPLICATION FOR. SANITATION PERMIT Permit No. __14Q.,�, ,4.7 '------- - (Complete in Duplicate) Y74-1(l �' Thi s Permit Ex fires Year From Date issuedDate 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 madein complian vw Coun!yQrd No. 549. JOB ADDRESS AND LOCATION___--------- ---------------------------------�' w ' ----- E? + --------------- ------------------------------------------------ ---Owner's Name_ --------- Pone-----••-------- ri--- -- -------- Address------ -•-------------------- •-•-- ' r ---- --------- -------------------------------•--,----------------•- ----------------•----------------------------------------------------------------------------- Contractor.s Name--- ------=-------- -��-- ---- -------------- Phone---------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [� Other Number of living units: ------- Number of bedrooms -------- Number of baths _3__ Lot size ---------- Water Supply: Public:system ❑ Community system ❑ Private 2---D'epth to Water Table -------• ft. Character of soil to a depth`of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Ciay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: '{If yes,date....................l No,O' New Construction: Yes -Er No C] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t No se fic tank or cesspool permitted if public s wer is available within 200 feet.) Septic Tank: p • Distance-from nearest well from foundation__./_4,-.:_----.Material-__ --------- _ - A No. of compartments_._____.__'2r---____Size__L - - '�- f - - CapacifiY--- I ,� i .. Disposal Field. Distance from nearest well__-f-._0._._.Distance from foundation__.- __Distance to nearest lot lit�e___�?"f____ a Number of lines_-___._.______""__2�_-_--.-__-" Length of each line---------fitrc----------- -'-- ----`-_ ----.Width french.�`--TYPe of flter material----- Depth of filter materal_--_. P--'-/------ len th ---/-------=-•-��—:_=_-.-.-.=-=-----_-"_. _ -------- Seepage ---_•--Seepage Pit: Distance to nearest well__- a-.._ . ________________Distance frm foundation__:______...._.__.Distance to nearest lot lme_: ------------- --------- Number of pits__"_--'-? - ---Lining,material___ __G�. Size: Diamefer___ ?_,,/.-/f---Depth_-____ `- ------------ Cesspool: Distance from nearest well--- _------Distance from foundation____________________Lining material_.El ______._ 1 7_77 p --------------------------- Y meter De th°` x-----"- -------Liquid Capacity----- -------=--- gals. - Size: Dia from l nearest well____-.-_-___. _ .'--------------------------------Distancetfro n nearest building----------------------------------- riv Distance to nearest lot line___._, F , ❑ Distance -----------------------------------------------•-------- ------------- ---------------------- Remodeling ------- -Remodeling and/or repairing-(describe).-------------_-.------------------------------------------- ---------••--•--------------•----- ---------------------------------------------- __ r - -------------•-- - ---------------------------------------------------------- ------- ----------------------------------________________________________ 1 - -------------------------•-----------------------------------------.. ---------------------------------------•--------------------------- I hereby certify that I have peared is application and that the work will be done in accordance with San Joaquin County ; ordinances, State laws, and riilesf d re' ations of the San Joaquin Local Health District. .�. . (Signed) •------ ---------- (Owner and/or ontract By:.. t - or C or] -- -------- -•------------------------------------- - ----------- ------(Ti le}------ ------- (Plot plan, showing size.of lot, cation.of. ystem in relation to wells, buildings, etc.,,can be placed on reverse side). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- -- -------------- --------------- DATE-------- --- -------------------------------- REVIEWED BY - ------------------ •---------------- =--- -- DATE------ ----------------------------------------------------- BUILDING PERMIT ISSUED----"--•----- ------------------------------------------------------ DATE----------------------- - - -= , Alterations and/or recommendations:. --- y° -c - -< , = ' ------ e� ' ----- t �=---------------------------------------- �! 2 �/ FINAL INSPECTION BY:.LL�---- ---------------------'----------- -------- - 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 ES 9 REVISED a-59 3M 3-'63 F.P.Ca. t '