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/ FOR OFFICE USE: -------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) --------�d�-7� -------- --- --This-Permit Expires 1 Year,From Date Issued Date Issued Application is hereby made.fio,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___ ,e .p _ 44 0- /----------------------------------------------------------- -------------------------------- Owner's Name___6? F.l_. __ ------------•-----------------------------------•-------------------------------------------...... Phone------------------------------------ ----- -- ---------------------------------------------------------------------••---•-----------------------------------------------------------------••--------- Contractor's --- ----- ------I •`- -------- ---------------------...---•-------•----:.,.,Pone.---,•----•----•---•---•---------- _. m.- Installation will serve: sResidence Apartment House ❑ Commercial ❑ Trailer Court-❑ Mot;Plo -tither [ F� JJ Number of living units:i_!-._.Nur»ber of bedrooms_ Number of baths � /�_� ---•--- Lot size _�------ --•�� '---------- � Water.Sup�ly: Public system ❑ . Commgnity system �tXrivate E] Depth to Water Table gwft. ;, ,;- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E?'ITardpan ❑ Previous Application Made: (If yes,date____________________1 No New Construction: 'Yes ®/Ido WAP FHA/VA: Yes [ o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`o� cesspool permitted if public sewer is available within 200 feet,). Septic Tank: Dista•<nce fiori newest well —_`Distah&�j�ro,mf,,o//undation-_�f _Mat Lie Pte. r y_No. ofcompartments_.-- q 'd .Capacit ---------- a __ _.- Disposal Eield: Distance from nearest well--- _-' -----Distance f o foyndafio - � ._ Distance to nearest lot lin, € ---- ------ Number of lines _-- �' r ' �_.. _Length o�ea�l{�'ine� _:---.�`�_-_.Width of trench--,._`�_•_--_-._==.-_-:-:�-�_---_--•-- Type of filter materialp De #h of filter mate`rel__,��_.__`-_-Total length__27 . _--_!'-r-- or Seepage Distance to nearest well ___-�^ _�.____ Distance fr m fou d,ationA�_ __.pis �`ce to nearest lot line URI Number-of-pits_ --------- Lining_rrta#erial.: Size:. Diameter_ __ pepth. a ------ Cesspool: --Cesspoo : Distance from nearest well-________________Distance from foundation_------------------Lining material__--.__ :__._fir_--__--- [❑ Size: Diameter--------------------------------------De th----------------------------- ------------Li,quid Ca acit Y------------ --------------gals.i O , Privy: Distance from nearest well.--.-______._-_________________________________Distance from nearest.building-j.____--.__------.s_.________-...__._- Distance to nearest lot line-•- -- ❑ ` -•- --------------------- --- -- - -------------------- - ------------ ----�`- �------ -�.. a �.I Remodeling and/or repairing (describe)--- -------------------•-----------------------------------•--------------•---------------------------------------•---------------------------• -- ; ---- - 1 1 I hereby certify Wat I have prepared this application and that the work will be done-in.accordance with San Joaquin County ordinances, State laws,land rules and regulations of the San JoaquinlLocal Health District. (Signed} ----- - -- ----- -------- --- ------- --- - ---- -- -�-- ------------------------------- - = r Contractor] By: - --------(Titlep`eace4d f (Plot plan, showing size of lot, location of syste relation to wells,.buildings, etc., can be nr onreverse side). r FOR DEPARTMENT USE ONLY - , ,� - � 1APPLICATION ACCEPTED BY------ � '_� 'T DATE �� --------------- ------------- DATE-------- -- , (BUILDING PERMIT ISSUED--------------- - --------X-- --------------.--------------------=-- Df�TE_ Alterations and/or recommendations._ -- -------_---------------------------- -- - __ clP4=�--_J----- `= � / — �- _. 7 F - ---- -------------------------------------------------------__ ____._..._-._.-___•-------------------- --�_ _ _____ x ,_ , FINAL INSPECTION BY... ------- -------- -- - Gtti' � Date ----------- t SAN JOAQUIN LOCAL;HEALTH DI TRICi;i 1 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 west 91h Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 9.59 31A 3-'63 F.P.CD.