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i FOR OFFICE USE: r� APPLICATION FOR SANITATION PERMIT Permit No. .Z 2- �/1 -- ----------- [Complete in Duplicate) S t ---------------- ,. Date Issued ___ I ........ RThis 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 with County Ordinance No. 549. N btu S 1Scs�`Q-s JOB ADDRESS AND LOCATION- Q - r '^ Owneh'sNam IL- w:-- - --------------------------------- -------- ---------------------- ----------------------- Phone_.. -•----------•------••-•-------- 'Address � �_. ----------- ----'---•----------� ti r _ _ -. one . Name---------------------------------- -=---------�-,rr""--•----• � T _ —• .. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other r. F i t Number of living units: ___t___ Number of bedrooms , r� Number of baths =/____ Lot size _&_1__X.. ----------_______.......__--------- i •s � Water Supply: Public system .] Community system ❑ Private Depth to Water Table -. _____ ft. Character of soil to a depth of 3 feet: Sand C] Gravel E] Sandy Loam ❑ Clay Loam ❑ ClayAdobe E] Hardpan ❑ pp • ( y ❑ coon: Yes [► Nb ❑ FHA/VA: Yes ❑ No ❑ Previous Application Made: if es,date____..__--- } No New Constru i TYPE OF INSTALLATION AND SPECIFICATIONS: : N- (No septic tank'-or cesspool permitted if public sewer is available within 200 feet.) 1 aro W Septic ank: Distance from nearest well--- Distan"tom foundation_--1__U______.Materia_.___ -_________________________ No. of compartments------ �"----------- _'X_ __Liquid.depth -' ' ' p Y -_Sizer_____. _Ca acct l�act t � ! ! i i =N Disposal geld: Distance from nearest well__'.__ _Distance from foundation, to nearest lot line__ ---_.__. g � < 2 ` fl1 of lines-----::-__-•ate -------------Len Length of each line---_ _4.'----'�- -__-_--.Width of trench---------'-------------_---------- Number Type of filter• mat erial_______S_,�______Depth of filter material____. ----- .__x-_'-.Total length_____/_L2iQ__________________________- Seepa Pit: Distance to nearest well-----f 40-0 Distance from foundation: 1__Q_ __.___.Distance to nearest lot line__>f_____-__ Number of pits._.----�.------Lining material___ -. ---____ Size''DiaM_ fer.-------3.7-ter.__.Dept h------- _5!___________ __ ._ '4 Cesspool: m Distance from nearest well-----------------Distance from•#oundation-----.-._...--------Lining materia ------ ----------------------------- . ❑ Size: Diameter----------------------- ------Depth--==-----------------------------------------------.Liquid Capacity----------- •----- -----=---gals. 3 � Privy.- .Distance from nearest well----------------4-------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line----------------------------------------------------------------------------------------------------------------:--------------------------- -- I 1 Remodeling and/or repairing (describe):----------------- -- --- ------------ --------------------------------------------;-------------------------------:---------------------- ------------ r r -------••---•---------------------- •-----------------------•-----•-•---•--------------------•---------------------------•-•---•----------------•-••--------- ---- -- ------------------------------------ --------------------------•------------------•--••------------------------------------------------------ ---------- I --------I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State rules and regulation f the San Joaquin Loca! Health District. (Signed)--------- ---- ---•--- ---'----- - - ------------------------ ---------- - nd or ContractorPlot tan. showing size of lot, lo-------- ----------' --- ------- --- -------------------------------------(Title)-------------- ---- -------- ----------------------- --------- ----- --- - -- ( p cation of system in relation to ells, buildings, etc., can be.placed on reverse side)._ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' ----------------------------------------- DATE---- ~ REVIEWEDBY - -------------------------'--'-'-'-----'- ---'-'------------ ------------------I----------------•----------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------------- - .- ----- DATE-•------------------------ - Alterationsand/or recommendations------------------ -------- ----------------------------------------___--------------------------------------------------I------------------ -----•--- -- -' • -------------------------------- - ----------------------------------------------------------- ------------------------------------------ --------------------------- --•-------------------- .-----.•---._------------- ------------------- ----------•-•----------------•--------- ------- -------------------------------------------------------------------------------------------------:------•------------------------------------------- -----•-------------•--------------------- -------'---------•------•---------------------------------------- - ------------ --- -- -------------------- ------------------------•------ - --------------------------------•---•------------•--------•--------------------- ------'------------- -------------------------------------------- FINAL INS . PECTION BY:---- '-'-'-- - '-i�� -- -------- - Date--6.-36-_-4 ------------------------------------------------ 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 1 ES 9 REVl6ED 8.59 3M 3-'63 F.R.CC. 4 l