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FOR OFFICE USE 4. ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ../.---1°- - _-17 �"" ' --------------------- ------------------------------ (Complete in Duplicate). / r - � This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549. vY//-,JOB ADDRESS AND LOCATION - 7__11 C!}T / _--- �- --------. °-�' Owner's Name------- ` --------- ----------- - -`------------------------------------- Address ---------- ---------------------- Address....- Qf�� ! -------- _ ; ~ /Y - y----. -��.1�------l7 4=..�...---------_----•----- /?�r. Fi�ZI !vci s- i Contractor's Name-------- ---------Iev—c-------------------------------------- Phonelxl�oe, :6Q__` .. '- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ® /�iov� rt Number of living units:--------- Number of bedrooms -------- Number of baths __ ,Lot size ------------------------------------------------------------ Water Supply: Public system ❑ Community system [I Private ❑ Depth to.Water Table -------- ft. Character of soil to a depth of 3 feet:r Sand E] Gravel E] Sandy Loam El Clay Loam ❑ Clay E] Adobe �ardpan C3Previous Application Made: (If yes,date-------- ) No [4' New Construction: Yes .❑ No 2--'FHA/VA: Yes ❑ No Imo" V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Y r Septic Tank: Distance from nearest wei4-----------------Distance from foundation----------------- _.Material_.:----____._.-_______k------------------------- ❑ ��C(s�►�� No. of compartments--------------------------Size--------------------------------Liquid de -th---------- --t= --------Ca aci ' ---- Disposal Field: Distance from nearest well..................Distance from foundatior_ _f4-)---------Distance to nearest lot line_,_�j____ ' [A ey/6TP"' Number of lines---------- ------------------ -Length of each line---__/__Qa_'___,___LWidthlof trench---------- ----------- A-0 Type of filter material__ _�___ _..AIC___-Depth of filter material------_&-6....... .Total' length-----------------;710.0__,______ Seepage Pit: Distance to nearest well______________________Distance from foundation------------------ to nearest lot iine-----._______.__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter._-----------------..---.Depth_------I------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation---------------_4_Lining material__-____-_--_-_____..__________._____. ❑ Size: Diameter Depth $--- ----------------------- Liquid Capacity' ' gals. Priv Distance from nearest well--------------------------------------------------Distance from nearest buildin ` Y' ------------------------------------------ El ----------------------------------------- ❑ Distance to nearest lot line.----------•--=----------------------------------------------------------•------------------------------ ----------"------------------- ---- Remodeling' and/or repairing (describe):_---_..,0Y --- 7 - 4 ------- ------------------F------------------------- ------------••---•----------------------------------------- ------------------------------�---------------------- -------------------------------- ------------- -------------------------------------------------------------- --------------------=--------------------------------••--------------------- --------------- 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 and regulations of the�San Joaquin Lacal Health District. r (Signed)------------------x1. fl `c ------ ----- - - � -�- --------=------------ ---- -(0 ner and/or Contractor) By:.... - � - ' ' (Title} f f -- --- --------- -- (Plot plan, showing size of lot, location of system in relation to wells, buil ings, etc., can be placed on reverse side).' D TME USE ONL APPLICATION ACCEPTED BY-- ----- --:- ---- ---------- -------- -- ------------------ DATE--_ - --- ---- ---- -------------------- REVIEWEDBY---------------------------------------------- l---------------------- --------------------------------------------.. DATE------------- --------------------------- ----------- BUILDINGPERMIT ISSUED-----------------------�-------__-------- -------`------------ ------------------------------ DATE----------- --- --------------------------------------------- Aiterations and/or recommendations------------------------------------------------------------ ---------------------------•----------------- -- ---- -------------------------------------- F ------},t - ---- ------------------:- ----------------------------•------------=------------------------------------------•------•-------------------------- ---------- - --------------------------------------------------•--- -------------------------------------------------= ------------ ---- - ---------•----------- -- ----------- ---- -----•----------------------------------------------------- -------------•------------ FINAL INSPECTION BY:-' ----'-'-- ---- ---- ---- --- - - -- ---- r Dater------------ --------- ----------------------•---- SAN JOAQUI OCAL EALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3•'63 F.P.CO. q