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ORbrFICE`USE- _�d ��/fez- `___.•_.-_--.-. APPLICATION FOR SANITATION PERMIT Permit No. . Z3.._. ------------- ----------- --- ---- ------ (Complete in Duplicate) This Permit Expires 1 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 here-in described. This application is made in compliance with County Ordinance No. 549: JOB ADDRESS AND LOCA ION..._J_.*0- --�---- ' f Lyy t' °._----- F Owner's Name---- 4.r Phone. `5 rj-�--- Address------------- --.+.,3-- --•- - ------------------------------------------------ ----------------------•------------------------ Contractor's Name------ •-------- -- --- _.------------------------------•---------------------------------------------- Phone._"--------r�-b p i Installation will serve: Residence I Apartment House E] Commercial ❑ Trailer Court [-] Motel ❑ Other ❑ Number of living units: 2. Number of bedrooms ----� Number of baths __2n Lot size --------- ------------ Water '____-_.__Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ._60 ft. l� Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe Hardpan ❑ Previous Application Made: (If yes,date----------- _____) NotNew Construction: Yes ;' No ❑ FHA/VA: Yes ❑ No-A # --e • 4A.) TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: Distance from nearest well ---Distance from foundation-----/8_'______.Ma#�riah_+ €._ __--------- No. of compartments __ z<__..______--Capacity- `?--G� iL. �2 + - ___ Ul Disposal Field: I Distance from nearest well_1£+0-`__-_Distance from foundation___._/ .........Distance to nearest lot line---CIO!____ CNumber of lines_______; g — -.______..Width of trench_ _. . ' --------------- Type __________ Len th of each line_____.____ Type-of filter material___��.__!_ L'1�Depth of filter materiaL______/_�8'��__-_Total length____ _.O_` .- eepage Pit: ,t'`Distance to nearest well.../QQ_.......Distance from foundation----�0_�_._..Distance to nearest lot Number of pits..... ---L_Lining material___ Diameter------___. Depth ;` Cesspool: Distance from nearest well-----------------Distance from foundation-_ ------.--------Lining material__-___-__.__._____-___._,___--__-__ ; Size. Diameter - ----------------------------De th-----------------------•--•------------------- -----Liquid Capacity gals. / Priv Distance from en crest well___________________ Distance from nearest building # ❑ F Distance to nearest lot line-------•--------.y-------- --------------- ----------------------- _- ---- ----- ------------------ -------------------,_2 Remodeling and ar-re # -repairing describe -7))_ -ALL"L T -- EP ----- 'p 2 inS �£ f II 11 --------------- -- .. 4t ------------- --------------------- -------- '------------------.- ------ ------------------------------------------------------------------------------------------------------------------------------- I hereby certify I have prepared+his application and that the 'Work will be done it acro dan'ce"with San Joaquin Coun+y 4-41 Ob ordinances, St te•laws, and rules and regulations of the San Joaquin Local Health District.; ' l (Signed)-------- ---- - -----•- - - -------------- ------------ ---•------------------------- {O ner and/or Contractor) By: ? - (Title} (Plot plan, showingisiz of. Iota+ion of system in relation to wells, buildings, etc., cen be placed on�reverse side}. i FOR DEPARTMENT USE ONLY APPLICATION ACCENTED BY...---_..... - ......................r.EDATE---- � r� -------- ---------- -- - REVIEWED BY- '------------------------------- ----------------------- ------------------------------- DATE------- --- -----------}----------•---------------- -� •--- BUILDING PERMIT ISSUED--------------------- ------------------------------ ---------- � --------a..r.�DA.�..T.�E---:---------------------- .. � :�.a. ..� ' � Altera .on� d/� reco .mda . � f - r - - --tans ---------':- - � - - C_ ._G ! .._... ---------------------------- ------------ - • --- r i i a l ----------- ------------------------------------------------ ---------- ------=---------------#----------------------------------------------------------------------------------------- - ----- -.I /` FINAL INSPECTION�BY.� -� .G_2 -------------- ------- -------- Date 6M -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street v Stockton,California Lodi,Coliforniq` Manteca,California Tracy,California 9 REVISED B-59 3M 3-'63 F.P.CD.