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FOR OFFICE USE: •� i 4 3 4 ------------------=------------------------------------ APPLICATION FOR SANITATION PERMIT; Permit No. - ------------------------------------------------------- IIrr - ---------------------------------------------- ------- (Complete in Duplicate) _ Date Issued 7 `. ____-------_:------_____.--._..._ This Permit Expires 1 Year From Date Issued Application is hereby made to the SanJoaquin Local Health District for a permit to construct a install the w work herein des ed. '! �Ti c_•---i -�-= '- - •-"-ampliance with County Ordinanc NO. 549. r7��J Ia -= JOS ADDRESS AND LOCATION` _ , V ,e , . [ ,/ j U ------ --- one ... Owner s Name---- --------------------------- - --------------- ------ - - O Address__OW/ �r ----------------- ---•-- •-- -- - ------ = N � b. - Contractors Name-------- -- - - - - --- ----•• --•-- ----- - ------ ------- ---- --------------------- Phone----------------•-•---------------- 14 _ 4 � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number.of living units: __/---- Number•of bedrooms . -- Number'of baths �' of size .____.__-/-- ••-------- Water Supply: Public system 0 Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g] Hardpan ❑ Previous Application Made: (If yes date--------------------J No ❑ New Construction: Yes ❑ No [:] FHA/VA: Yes ❑ No ❑ r { TYPEOF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted.-if public sewer is available within 200 feet.) ..y Material---- /1-LAL..- = ------ y Septic ank: Distance from nearest well___.t'"�- -_ Dista ce�from f�oyyu//ndation_____. l ! f No. of compartments-------- ------Size _____ - ----i6- --Liquid depth------q----------------Capacity-----(.� _ �~ X-- Dispos field: Distance from nearest weli._ �r__�_Distance from-foundation__-_ _ -____.Distance to nearest lot line_ -._..: y Number of lines----- - ---- - -- --------Length of each line_��7�_G'_' f�s''.�_---Width of trench-- -_"'f--�.--------------:_.._ ��- Depth of.filter, materia!______ _ _ ________Total length___ Type of filter, materia_ �_ ^ ,. `r f + . ) rf~: �_�'_______Distance to nearest lot line _____. Seepag Pit: istance to nearest: well-__I _____Distance fr foundation______ Numberiofpits. .-:-� g Size: Diameter__-- f� _ De th__-- ------------------- # �-- ------ Lorin material-- _L%g' P Cesspool: Distance--Frorn nearest well_________________Distance from foundation-_--________-_____.Lining material,----_______-_-.-_______-_----______. ❑ Ns _.; I Dept -_ ------ ---= Li uid Ca acit a Size: Diameter__:.~�:�-'�-�.---------- --- P� "-- - ---------------: �{ Capacity -------•----9 �' - � t , Privy: Distance from nearest well-___-------------------------------------------Distance from nearest.building____.____--______-_--_______-------_---- w.- ❑ to nearest 4ot line' -------------------=------------ ---------------- ------------------------- ------------------------------ Distance ------- . Remodeling and/or repairing (describe):------------- ------------ ------ ------------------------_:::-----=----� --------------------------------------- � h. -- i -- ----------------------------------------------------------- ------------------- - -------------- ��t -- --------- ---------------------------------------------- :_ + - � -----------'--------.-------- - I hereby ce •� that l have prepared this application and that the work�ill-b-e_-done••in-accoraance with San Joaquin County `7 ordinances, St laif y and rules and re ulations o a JoaquinLocalHealth D'is`trict. (Signed)------- d/or. Contractor) ------- -� ....(Plot plan,,showmg size of to+;oca+ion-o systemwin-refat' n-+o'we11s, *u'dingsr etc.—, can -be-placed onleverse_side).� I FOR DEPARTMENT USE ONLY, • APPLICATION ACCEPTED BY_ .- __-- DATE -- > . - -- - =w R REVIEWERBY jT �----- ._ DATE-------------------- .-'"-- `;* BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------ ----------,,DATE---------------------------- --------- Alterations and/or recommendations------------------- ------- -----------------------------------------------------------•---------------- -------------------------------------- ---------- ----=-----•-- -------------------------------------------------- ------------------------ •---- ----------------- FINAL INSPECTION BY' Y i' - ------------------• Date---�'---------` ----------- --------------------------- -- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California. Tracy,California 1 ES 9 ReV,SED e•59 3M 3-'63 F.P.CO. _