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FOR OFFICE USE: /- ----------------.._ . APPLICATION PO`R SANITATION PERMIT Permit No. . � M- ----------------------------------------- ----------_--- (Complete in Duplica+e}.- " ' Date'Issued ___________________________ :_`_._ This Permit Expires 1 Year From Date 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 compli nce with County Ordinance No. 549. rj JOB ADDRESS AND LOCATION. .`_ 7 -- Owner's Name --------- 'A0- ------- -� Pho'ne...... = --------------------------------------- -- ---------- Address Jl.f T _. Contractor's Name__._.....r e -----------------••--•-------------- ---------------- ----- ---------------------------- Phone.------------------------...._..__- Installation will serve: Reside (� Apartment House ❑ Commercial ❑ Trailer Court ❑ _Motel ❑-1Other ❑ Number of living units: _1______ Number,of bedrooms _ ,:_ Number of baths ___-I-- Lot size ___lV_-�_.-_____ 1-r__________________'_________ Water Supply: Public system F71 . Community system [:1Privatep Depth to Water Table c:�___ ft. I � Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-------------________1 NoNew Construction: Yes No ❑ FHA/VA: Yes ❑ NOX TYPE OF.INSTALLATION AND SPECIFICATIONS:- (No septic to k or cesspool permitted if public sewer is araila6le within 200 feet.) '� V Se tic Tank: Distance from nearest well__6.0-----Distan a from foundation____�_i�__._,__._.Ml arial_�--� , No. of eompartmerits_.2 �_�.________.__Size __ _ _______Liquid d th___-_ ---"�__.____.:Capacity-.I_� ..�__. Disposal Field: Distance from nearest well---7Q.......Distance from foundation:__ 1.J---------Distance to nearest lot li ey. _ _.-_ Number of lines------ _____ Length of each line------ -Q_______ Tf _Width of trench. ------------------ Type of.filter materiah-._1__. _ ____ Depth of filtematerial aterial______ _-____=Total length__ ______:_____..__- Seepage Pit: Distance to nearest well----------------------_Distance from foundation---------------------Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material -_-------------_--__ -Size: Diameter-_---------------------.Depth_------------------------------ � Cesspool: Distance from nearest well------------------Distance from foundation__---- ---------- Lining material__.-______-.__.-____-_____________-__- I ❑ Size: Diameter------------------------------------- Depth---------------------------------------------------Liquid Capacity-----------------------_--gals. y: _ ________________'--_�-:._Distance:from nearest.bui2in'g"-"��_-'�___:___ Distance fro earestrwell__._____`______:_-__ _ _ __-____. l ❑ Distance to nearest lot line--------------- ---- --------------------------------------------=------------------------------------------------------------------- Remodeling and/or repairing (describe) --------------------------------------------------------------------- =----------• •---••-- ---•-----••--------------------------•----•---------------------------------------------------`-------------------------------------------------------------------------------------•--------------------------------------- ---------------------------------------------------•------------=--•---•--•----:-------_-----------•----------------=-------------•-•--------------------------------------------•------------ ' ------------------------------------- ---------------•---------------------I------------------------------------------------------------------------------------------------------------------ -------------- 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 rul s �nd regulations of the San Jaa'quin Local Health District. (Signed} --------- ---------------------------- -- ---- ----------- ----- ---- -------------------.(Owner and/or Contractor) --------------- -- - By'--- --------------- -------- ------• ....s - - _...---- --- _-„-. ---- --(Tifle)-�:.-,xm ................................... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,.can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ DATE---c �------`---------- ----------- ------ -------- REVIEWED BY - DATE --------Z:--------------•---------------------- y BUILDING PERMIT ISSUED________________________ X� -- - ---- ---------- - --y------------------_--------------------------------- DATE----------------------'----- 'L--) _ ---------------- Alterations and/or recommendations:----- =--- ----- ------ --------------------------- ---- ------------- --•- `------I------------- - - - �: •- - - - - ------:-------------------- ------------------------------- s - y-y- _ _.-._ OPrEi2. a r c uT_l . '1— ;5 _ 1` �r N�.rr FINAL INSPECTION BY:.--- J --------------- ----------`----------- ~ . Date----------------------------- - ........ --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT t a 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California I [s 9 REVISED B-59 3M 3-'63 F.P.CC. I i