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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . c � ------- -- ------------------------ -- {Complete in Duplicate) Date issued _A9:,./__Z/x _______________________ This Permit Expires 1 Year From Date Issued Applica.tion is hereby made to the San Joaquin Local Health District for a permit to construct and install ther,herein descri4ed. This application is made in compliance-with County Ordinance No. 549. f JOB ADDRESS AND LOCATION__`_, /f --- ------- --�/-- -,�----• -�T1`�'�-/ G� Owner's Name--- --- ----- - x-- :------------- Phone------------------------------------ / -- --- ----------•----•----------------------- Address------/Y�7� rf---�---��------- �-..�� F,+ �� =' �p '�f Contractor's Name-----16.7.5---7v— -a.1-,��,_o,_&---------------••- -----------------------------------•------------ -• ------------ Phone...---•---------.___----------- Installation will serve: Residence gEj� Apartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other ElT Number of living units: _/___ Number of bedrooms , - Number of baths -t'+-�---- Lot size P--l'eAg-�_________________________--:_.. r Water Supply: Public system El Community system E] Private Depth to Water Table 7ft. Character of soil to a depth of 3 feet: 1 Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan 0 Previous Application Made: (If yes,date--------------------) No 2'. New Construction: Yes ®-'I�O ❑ FHA/VA: Yes �o , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perrnit#ed if public sewer is available within 200 feet.) F Septic Tank: Distance from nearest well-IAV---Distance from foundation---/49 Mat rias. � No. of compartments___ Size � 3q pt _ Cp y � Disposal Field: Distance from nearest wellZaa----Distance from foundation_A -----------Distance to nearest lot line__t�__�___ Number of lines______A____________ _ Length of each line_Ze9a_�_---_______._.Width of trench-1__.________.__-'-- TT e of filter material' -Depth of filter material__ ___ __"` Total length__ 4. _ ype p / ----- = Seepage Pit: Distance to nearest well_f_x1_(9-------Distance f M-foruuu'ndation___f*�___�-_.Distance to nearest lot li e_.r Number of pits____��___.........___Lining material- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------ El Size: Diameter----------------- --------------------Depth---------------------------•----------------------.-Liquid Capacity----------------------------gals. Privy: Distance from .nearest well-------------------------------------------------Distance from,nearest building--------------•----------------------_.._. ❑ Distance to nearest lot line------------------- - - -----------------------------------------•------------------------------------------------------------------------ Remodeling and/or repairing (describe): ---------------------------•-----------------------. ---------------- ------ = -- , 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 and regulations of the San Joaquin Local Health District. *r -. ./rye (Signed) ® r- I t1•{+ 6' /--��'�� ; (Oav Contractor)_4 13 f - - - -- ---- - --------------- (Title)-- F ' �h� --------- ------- ----- (Plot plan,.showing size of lot, location of system.i r ation to wells, buildings, etc., can be placed.on reverse.side). FOR DEPARTMENT USE ONLY ' I APPLICATION ACCEPTED BY-- -- ------ ------- ---- -------------------- ------- DATE__/_ __�_ 74 --- REVIEWED BY------------------------- ---------- ------:---------------------- -' DATE 3 # :1. ----------- ---------------- BUILDINGPERMIT ISSUED.---------------•--------'--------------------------------------- ---------------------------------_ DATE---------------`--:------------=----------=----------------- •,.. ------------------------------------ AI#era#ions and/or recommendations:------------------- -----------------------------------------------------------• ---- -------•---------------------------- ----------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- i - ----•----------------" --------------------------------------------------------- - -------------------------------------------------------------------------------------- ----------•------ -----------••---- ......... --------•- -------------------------- -------------------- ------------------------- --------------------------- -------------------------------------------------- FINAL INSPECTION BY:..- 7 Date ' �°� --- ---------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Avvt k 300 West Oak Street 't 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California by :. ES 9 FOEVIr EO 9.59 3M 3•'63 F.P.CO. �