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FOR OFFICE USE: _ r rf ----------------- �� " ----- APPLICATION FOR SANITATION "PERMIT Permit No... _ _3_ ._. � --------------------------------------- --------- (Complete in Duplicate) s" G/ This Permit Expires 1 Year From Date Issued Date Issued"_.____ 7 Application is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 9 � k F /� 1 6 JOB ADDRESS AND LOCATION...c��k [f-.------`------� b_________________a:e _ �� -r i 4 - Phone Owner's Name �'� ;,irk�`r� - ,c.� -— -------------- ne-----------------------••----------- Address------- ....___ -- -------- i -----------•--------------•--------•--•---•--- Contractor's Name_. 0Q ....__,- i C--- `' c`t'P Phone ... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El- Number of living units: __il_,_ Number of bedrooms _3__- Number-of baths __ -.Lot size Water Supply: Public System ❑ Com,munity system ❑ Private t[ epth to Water Table _.40ft. _ Character of soil to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan❑ Previous Application Made: (If yes,dare_____________ No`E---Naw Construction: Yes n—No ❑ FHA/VA: Yes ❑ 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__-_'5R _.__Distance from foundation_��_____.:___.Material_._ _-- ----- .1- �( No. of"compartments-.-.-_- _--------------Sizer---= -x F __` _._--Liquid depth___9__`__-------------Capacity---e-00I `1 Disposal Field: Distance from nearest well._IrP_------Distance from foundation___Z_ -----------Distance to nearest lot 1�] Number'of lines----,--------------------------Length of each line-7 3._---------------------Width of trench_� -`_-____.___--_- Type of filter material___1_�S_�(--------Depth of filter material_l -_`_______._Total length----/41�__`______________________ Seepage Pit: Distance to nearest well_ Q_`_---_____Dsstan om foundation__`?Z�._..........Distance to nearest lot [L] Number of pits.__ -------------Lining mate ria -1-P-�_4-_---_.Size: Diameter---- - •.-.`.---Depth____�;5"'--------------- , Cesspool: Distance from nearest well_________-------Distance 1from foundation--------------------Lining material__.________-____---_-__-________.._ ❑ 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:_________________ ___ _ ----=----------------------------------------•--------- ---------------------- ---------------------------•- P .E -------------------------------_---------------------_-----------------__----------------------- _--------------------------------------------------------- _---------------------------------------------------------------------- _______________.__.___-______________-__-.____--.-____________________•_______-____-__________-.___________-__._.-____.-------------------------------_------.-------------------------------------------------- -------------__---------------------------------------------------------------------------------i-_________-_________________________________.-________________.________________.._____.___-_._____.______-_----------------- I hereby certify that I have prepared this applicatiotl'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. ISi ned `� g ) ------- -- --- ----------(Owner and/or Contractor) Sy:--------------- -••- :------ --------------------------------------------------------------------[Title)- _010 nAl-SI-i..------------------ - N-ZI (Plot plan, showing size of lot,.location of.system in relation to wells,f.buildings, etc., can be placed on reverse side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -- - -- � - ----- `- ----------------------------- DATE------ �---- TREVIEWED BY l DA - BUILDING PERMIT ISSUED---------------•-------------------- ----- -----------------------=----- -- DATE. Alterations and/or recommendations:----�P_-! _�_to._ 1 ]k�_ _. JA-- _ �s s--'------------------- �----�-�-----------------..::------------------------------------- ------- _ - ` ------------------------ -------- -------- + #f_ C �'y F . -- ---- X%------------- j ..^^� {� C-�. --I -t�- ----2 -tr _ __ L'�S= - --- ---------- y-----r-- ---- -------- 2 -----— - -��-•J��-- --------------- FINALINSPECTION BY:.. - ---- ------------------------------------ Date--------------------------------- - ------------------------------------•----- -- SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California / Lodi,California Manteca,California Tracy,California /A &6 9-ArViSEp 13-59 3M 3-'63 F.P. r/