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OR OFFICE USE; '1 y - - - ----- -- d1 APPLICATION FOR SANITATION PERMIT Permit No. --------------- .�- -- _. (Compl'efe in Duplicate] / Date issued. _--------------------- ---- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healthl District for a permit to construct and install the work herein described. This application is made in compliance with County Orclina'ce No. 549. JOB ADDRESS AND L ATION-------•---- - �p �' N _ " ---- Phone------------------------------------ Owners Name-------------�---�---�G .-_�`-t--d�-�.S�----------------------------- ----=---- -------- -=--------- ----- ------ :Sv Address.- 7- .. G� I -----------------•-- -----------• - Contractor's Name----------•--------- a ------------• •------------ ---------- Phone------------------------•----- --------------- Installation will serve: Residence Er-Apartment House ❑ Commercial ❑ Trailer- Court ❑ Motel ❑ Other ❑ er of bedrooms -Z,-- L _ Number of baths _ ____ Lot size ._ -, '--------------------------------- Water Number of living units: ----1,,NWaterSupply: Public system Community system ❑ :Private ❑ Depth to Water Table,/,__Sr_ft. Character of soil to°a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam El Clay Loam El C1 El Adobe ardpan ❑ k \ Previous Application Made: (If yes,date--------------------I Nc`❑ New Consffuction: Yes o ❑ FHA/VA: Yes F] No ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / Septtiic T�. Distance from nearest well___,./*---Distance from foundation/ia__---____.M �rial__5-. __________________ g_-------- No. of compartments------------ > X_ -_--Liquid depth_ ---. .� -.-_-------Capacity--- -------/----- Disposal ield: Distance from nearest well----------------iDistance from foundation___ .-_.Distance to nearest lot lin .,g �� -- ' 3 Number of lines---------- ----- Len th of each line-----_---___.__ Width of trench__-- -----_---- --------- Type of filter material__ _``!'+ C_�"epth of filter material___ - ---_Total length------�rJ ------------ ------- Seep it: Distance to nearest well.-er��_._---_Distance from foundation,,) -./____.=_.Distance to nearest lot lin� _.--__..._ Linin material_____.t _/,.Size: Diameters_3�_ ----_-_.___---_Depth_. ---. Number of pits__- ...______� g l -- i - �' Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material---------------------- _ -________. _ ❑ Size: Diameter--------------------------------------Depth---------------- -------------------------------Liquid Capacity------------------- -------gals. t Privy: Distance from nearest well---------____._____-��-----------------------------Distance from nearest building_____--___._________________---:---------. 1 ❑ Distance to nearest lot line - ------------ I Remodeling and/or repairing (describe):---------- .. -------- --•-•' /i �� _ - -- ----------- ------------------------- --- ------- i - I hereby ce i t I p pared this application and that the work will-be done in accordance with San Joaquin County ordinances, Sta a , an d regulations of the San Joaquin Local Health District. I l _ __.-__ -------(Owner and/or Contractor) (Signed) --- (Title) (Plot plan, showing si lot, location of syste to relation to wells,-buildings, etc., can be paced on reverse side). FOR DEP RTMENT USE ONLY / APPLICATION ACCEPT ------ --- --- --------------------------- DATE --------- REVIEWED BY___________ _ ___ Il DATE ----------------------•------- DATE------------------- - BUILDING PERMIT ISSUED------------- -•---------------------------------,;�� ----------------------- --Y---------------- •. .�.. - - 4 x � c � ✓ -oOr Alterations and/or recommendations:----: _��1._... 7_ __. = ------ '1 cJ l ---------- -------- : I>t1_. �l 7,q�.✓ ----c--r-rl--P-_- ^y-�� -._-... t.-- -------- ----- ---------------------- ��'7lry'Y�= _ ----------- ` ` �1ice_ ----------------------------------------- �� r�, FINAL INSPECTION BY:--- ------------------ Date s i - a -� SAN JOAQUIN LOCAL HEALTH DISTRICT l; 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California .l Manteca,California Tracy,California E5 9 REVISED U-59 3M 3-'63 F.P-C4- IR