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FOR OFFICE USE: ------------ -------- --------- -----------------------------------_-------------- APPLICATION FOR %SANITATION PERMIT Permit No. -------------------------- ------------------ (Complete in Duplicate) Date Issued _0134f x/. --------------------------------L........ ------- This Permit Expires I Year From Date Issued r---------i------ 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 LOCATION ....... - -------- --- ----- Owner's Name----"rN_ -4&_ *--------------------------------------------------------- �_-------------------------------------------------------------- Address----- ............. I -----------------------------------------------------------------------I------------ 0 Contractor's Name--------------- P h o n7 7 Installation will serve:. -Residence Apartment House E] Commercial E] 'Trailer Court ❑ Motel E] Other E] Number of livingunits: .-I----- Number of bedrooms Number of baths.,--i__. Lot size --- ...... ----------------------- Water Supply. Public system El Community system E] Private Depth to1Water.,TPbIe._4b_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel [] Sandy Loam Ej I Clay Loam E] Clay C] Adobe Hardpan El Previous Application Made: (if yes,date------ ----------- -) No New Construction: Yes No ❑ X FHA/VA: Yes E] 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----&0_ ---Distance from foundation..-... T 'al ---------- No. of cornparfmenf------------ depjh---- 5-----------C 'a pacify_eoo_&„kF Disposal Field: Distance from nearest well--- Distance from foundalion..... Distance to nearest lot line-----, Number of lines......__"... .._---______Length of each line--- ............-Width of trench l...... Type of filter materials i-- ------Depth.of filter material-------441-11---.-Total length-----------------�a.-4---------------- Seepage Pit: Distance to nearest well......................Distance from founclafior�----__...'._.Distance to nearest lot line................_ ❑ ine-------------- El Number of pits------ ---------------Lining material---------------------- Size: Diameter------------------7----Depth--------------------- ------ Cesspool: eptk--------------------------------- Cesspool: Distance from nearest well.................Distance from foundation-------------------Lining material---I——-------------------I---------- El Size. Diameter'------------------------------- Depth------ ---------------------------------------------Liquid Capacity!-- ----------------------gals. IT Privy: Distance from nearest well----------------------------------------------Distance from nearest building-__-------.....__-...._.--.____.__.___. ❑ Distance to nearest lot Iine--------------------------------------------------------------------------- Remodeling and/or repairing {describe):------ai,.--- ------- -------- ------------------------- ---------------------------------------------------------- ------------------------ -------------I----------------- ---------- --- --------------------------------------------------------------------------------- P - ..'!==-6---------------------------- - .1 ----------------------------------------------------------------------------- ---•---- -------------------------------------------------••--••---------•----------I-------------------6---------------------------- ---------------------------------t- -------fy_ I hereby certify that I have prepared this application and that the work will done-in accordance-with San Joaquin �&,n ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) . --------------Z-------------------- I--------------------------------------------------- ner.and/or Contractor) - --- --- ------ - ---------=--------------------------------------•-----------(Title)---------4 1r, ---- -- - ---- By:----------------R41 of fen, (Plot plan, showing size of lot, locati� of.system in relation to wells, buildings, etc.,'can be placed on reverse 'Side). --- I : I J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED-BY---- ----- _" DATE----`G' ?- ._.................. REVIEWEDBY------------------------------------------------------- -------- --------------- -------------------------------------------DATE-------------------- BUILDING PERMIT ISSUED----------------------- ------------------------------------ i I ....... ----------------I----------------- DATE---------- ------- ---------------- ---- - Alterations and/or recommendations:--.,-W--e�77�4��---------- ------------- ------ 2 7r-------- ------------------ T------------ --- --------- ------------------------ --------- JJ ----------------------------------------------------------------------------------------- ---------------------------------------------------------- ------------------ -----------------------------------------:---------- -------------------------- ---------- - ----------------------- ------------------------------:-------------1 - -------------16----------------I ----------------------------------------------- -------------------------------- ------------------------------------------------------------ ------------------------------- ------------------------------------------------- ---------------- ------------------------ -- - - - FINAL INSPECTIC�N_BY-7 ------ ----------- Date----- ------ ---------- -- —----------------------- - ------------ AN JOAQLIIIN.LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES8 REV1135ED B-S9 3M 3-'63 F,F.GQ.