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FOR OFFICE USE: -------------------------------------------------------- ��._ ------------------ ----- APPLICATION FOR SANITATION PERMIT Permit No. __�'_ -- �•_� --------------------------------------------------------- (Complete in Duplicate) This Permit Expires i Year From Date Issued bate 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. S49. JOB ADDRESS AND LOCATION......... Owner's Name �jeS.r -------------------------------•-----------------. Phone.,/p--.. ...... Address------- ----------------------------------------- -------------- --------------------•-•----------------------------•---- Contractor's•Name-----/lP.e_U-------__-- Phone---•-----__-._- ----•--------------••---------------------------•---------------------•• -- Installation will serve: Residence Apartment House i ❑ p ❑ ' Commercial ❑ Trailer Court ❑ Motel ❑1 Other 1K I Number of living uni+s: ________ Number of bedrooms -------- Number of baths ________ Lot size ______________________ Water Supply: Public system Community system ❑ Private [) Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ -Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: (If yes,date____________________) Nol) New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ 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__-n✓1?______Distance from foundafion------/D _,`Material___ No: of compartments_-r_-- - Size-----1 X+_' depth---------f----------------Capacity---- ,75 ¢ Disposal Field: Distance from nearest well___ �.L___-_,Distance,from foundation____ `� � _ ______._._-Distance to nearest lot line___$_____.._ XNumber I lines------------a/ _ -----`--,Length of each'line--------'90---------------..Width of french__A--/' ------------------•-- Type of filter material - ~_"- -Depth of filter material-------lF.�l______Total length---------Qdr_______________________ . _._. ... Seepage Pit: Distance to nearest well---------------------- from foundation....................Distance to nearest lot line-- ----- ❑ Number of pits--------i-------------Lining material----------.------:-----Size: Diameter-----------------------Depth.......... -------.--.------... Cesspool: Distance from nearest Well-----------------Distance from foundation___________________lining material----------------------____.---------- Size: Diameter----------'--------- ------------------Depth--------------------- -----------------------------Liquid Capacity gals. Privy Distance from nearest well____. ___________-----------------------------_Distance from nearest building � - . � _ g------------------------_-------------- 0 Distance tib nearest lot'line--- --- ---- ----------------------------------------------••------.---- Remodeling and/or repairing (describe):---------------.---------------------------------------- - ----------------------- --------------------------------------•--------------------------------------------- y ---•------------------ ---------•---------------------•----------------------------------------------------- ---------------------------------- I hereby certify that I have prepared this-application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District... (Signed)_ Owner - (OW - �y - and/or Contractor) sY ¢�✓�' Ti+le ----- (Plot plan showing size-of lot, location of ystem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ' r APPLICATION ACCEPTED BY- ��, ---�---- DATE-------`�7:7: .4_ REVIEWEDBY------------------------------- --------------- - --- DATE__ BUILDING PERMIT ISSUED ✓------------_ `__ _ ----------- -------------------- DATE. Alterations and/or recommendations•_ a ---- - G -_ � 77 =tom ` �------------------- - ---------------------------------- ---- FINAL INSPECTION BY: ._ r/ D ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Eg•9 REVIZE0 9-59 F.P.00.2M 6-60