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FOR OFFICE USE: ------------------------------- ------------------------ -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .lQ_7.- ------------------------- - ---------------------- ------. (Complete in Duplicate) - --- •`This Permit Expires 1 Year From Date Issued Date Issued _-15. 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. JOB ADDRESS AND LOCATI N-• - .�'Z/ [-�J, / _ -----•- --- ---- �---------------- ' C Owner's Name (-C4 ] 'y Phone--------------------------------- Address -- ..�_..J ----------------------------- -------- Contractor's Name-- Phone-"-_--------•------------=•---"-•- -- - ------------------- - - Installation will serve: Residence [�' Apart nt House ❑ ,.Commercial ❑ Trailer Court ❑ Motel LlOther ❑ Number of living units: --------- Number of bedrooms -------- Number'of baths ---1--- Lot size _______2,rl7y�� --------------- ------ Water Supply: Public-system ❑ Community system ❑ Private XDepth to Water Table ---�7`ft.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Efj�I-lardpan ❑ -Previaus.AP.plication Made: (ff.yes,dafie__ ____________ ___), No New Construction: -YesNo E] FHA/VA:•Yes El 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__-'7,- _Distance fr m foun&It.ion-----;111 ".Mate No. of compartments-_1-7-7 _ Size_ x=� Liquid dept - __--Capacity--- Disposal Field: Distance from nearest well 5- __._.Distance from foundation,__ -_- .".---.Distance to nearest lot line_6_6 - _ Type Number of lines_______-____._. --------------- -Length of each line-------�C?_________rv__._.Width of trench -Z��'__- r -------------- of filter material_�z_f Y1 -Depth of filter.mat ./-(,,----Total length-____.-4�'_a___--_______ � Seepage Pit: Distance to nearest well-------------_--------Distance from foundation---------------.---.Distance to nearest lot line----------------- 0 ❑ Number of pits----------------------Lining material_-----------------------Size: Diameter-------------------_Depth---------.---------- ------ C --- # Cesspool:. Distance from nearest well_________________Distance from foundation-------------------.f_ining .' , material------------------------------------- 0 _--..._-__________.________ - -- -❑ Size. Dlameter_ __- .__-------- ----- Depth_ -_ ______ ___ Liquid Capacity _ gals. Pr ---- stroiv : ance m €I nearest well__ ___. ____ _____ _______Distance from nearest building ------- ------- --------- El Distance to nearest lot line--------- ------------------------------------ ------------- Remodeling ------------- Remodeling and/or repairing (describe)-------------------------------------29:H,��iz4,-_-__--------_�__-_-_--- � T-- ----:-•-- ---- ---------•--------•- ----------•------------------------------- --------- �--= - ------------------- ----..---------------- �� --------------------------------------;----------------------•----------- ��---"-- " •� `' 1 ----- ------ - • - ----------------------- ------ -- ------ 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 r and regulations of the San Joaquin Local Health District. '� �- ��-••-�-—� �s,.,.,�_ s -�. .� -��-:a-._. . -------------------------------------- By - ---- ---------------• -- Owner and/or Contractor) BY- -------- ----------- ----- - ------ -------(Title)---- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- -----.__ DATE ''- ------ --- '-- REVIEWED BY - ------- -------_------------------------------------- _DATE- .:. BUILDING PERMIT ISSUED---------- v Alterationsd/o �ta�o� ndation rQ L�t -1- --------------•-------- - ----- _d -/ ..E. __ � -�•l� .-rte—' [ 4�.../li-' ,.".. r_ --------------- ------------------ ----------------- ------ lf�--r ,�- f----- 7/ • / -•----- FINAL INSPECTION BY:.............. - ----------`------`-Y----------- -----------Q-�---l---- Date---------- ----T ---�- ------4---�------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California " Manteca,California Tracy,California FS 9 REVISED 8-59 3M 3-'63 F.P.CD.