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FOR OFFICE USE: _• — ,� g � b APPLICATION FOR SANITATION PERMIT Permit No. Z_712:.�- L (Complete in Duplicate) r .-------.__F-�_____________________________ _____________ ---- 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 worVherein described. This -Opplication is made in compliance with County Ordinance No. 549. n x JOB ADDRESS AND LOCATION---` _- - � �. Owner's Name----1----- Add-ress �� ------------------------------------------------------------ -------------------------------------- Pone-----•-------- --------•-- k� u Z-- -------- ------------- --------------•-----------------•------ Contract)r`s Name___o -o_-_ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Nll nhP Mf...li.nn y 4- F KL.._t-__ t I ..I � ,..... t .� _��-.._ _ L] rL7 ✓.. E Installation wIIC serve: i. Residence ®Apartment House ❑ Commercial ❑ Trailer.Court ❑ Motel ❑ Other............... vnbracter"ot soil 10 a dept�of 3 feet:•-'Sarsd ❑ 'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date___________ ________1 No M�New Construction:' Yes [�J—No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 2p0 feet.) Septic rik: Distance from nearest welL.`��0- 6stance from foundation_�D -rs- _ -- •-----._Material-- ' No. of compartments----- -----------------Size.._.�_�_s?___X__ -__--Liquid depth-_- -_9--` -- Ot - ---- ----Capacity---�-- ---= -� ,� Disposal Field: Distance from nearest well_- "e---_Dis#ante from foundation____�d-- "_--.Distance to nearest lot line ---" - --- -' g r I ., w W Type 2 _ _",Depth of.fllter material___ -IS"_- Width n trench___ _______________________ u bof fifer matenal�p_r � - tLen!-Length of each line7c� ________"_ � S Total length Seepage Pit: Distance to nearest well__"��e_-f".---(Disfance from foundation---Iq--------- Distance to nearest lot I}_ne___�� [ Humber of pits__°Z—----- ------Lining rnateriaL__"1-_ >_!;A_.Size: Diameter____-f- ----.----Depth_-_ cS` -------------- Cesspool: Distance from nearest well_ _Distance f om foundation. ______.__..Lining material--.----------------- _____________ ❑ Size: Diameter--------- ------ Depth ' ------- - -- ----- -- -- ----- - - -------Liquid Capacity- ------ gals. Privy: Distance from.nearest well----------- ----------------------------__________Distance from nearest❑ building ------------------------- Distance to nearest lot line.-.____________________________,___�_____ Remodelingi and/or re describe]:-___'��_77----_- - _ _ �� ---------- -------- - --------- - ----- '--Z- --------------- __ c1?� _fir- r t; I hereby certify that I have prepared this applica and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules Land regulations of the San Joaquin Local"Health District. (Signed) ----= r� ----- _ - --------------------------------------------------------------�----------- -----------(Oiweraad orContractor)By:--•---------------2 -- r -P ----------------------------------------•--(Title)------------------ ----=----- ------ (Plot plan, showing.size of lot, location oftsystem in-relafton,to wells,,buildings,-etc.,.can be placed on reverse.side).. i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -- -- - ___ DATE------ -------------- ---------------------------------------- REVIEWED BY =----------------------- ----------------------- ------------------------•----------------•----------------------- DATE-- BUILDING PERMIT ISSUED -- ----------- DATE _ Alterations and/or recommendations:__--_------ (. , �_ � ��,��c— -------------- a'�- - -- ---- ---- ------ =------- --------------------- 9] -------------------------- ----------------- •----------------------------- FINAL INSPECTION BY:-- 4 ,lC' �! 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 e•50 3M 3-'63 F.P.Ctl.