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FOR OFFICE USE: V43 _ _ �: APPLICATION FOR SANITATION PERMIT.. Permit No. t ------------ (Complete in Duplicate) This Permit 'Expires i Year From Date Issued x Date issued ._e x 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. 4 30B ADDRESS LOCATION = f ---------------------------- ` Owner's Name ------ - --•--------------------- -=-_-----------------:------------------------- Phone------------------------------------ Address = -� — �---- fir{ Contractor's Name- -- ------ j ---------- ------------------ Phone------------•='-------------------- Installation will serve: Residence ER-"Apartment House ❑ Commercial ❑ Trailer Court ❑ t otel E] Other Eli Number of living units: _- -/-i- Number of bedrooms -!s_ Number of baths/ -___ Lot size S_%�_1___ '_�- j ---------------------- Water Supply: Public system"Q��mmunity system ❑ Private ❑ Depth to Water Table kJ_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam 0 Clay Loam ❑ C11 ❑ Adob Hardpan-❑ Previous Application Made: (If yes,date..............___..) No New Construction: Yes No ❑ FHA/VA: Yes ❑ Nd-tT ' t - TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted'if public sewer is available within 200 feet.) No. of compartments...____ ____Size______ ationlC v---- ____. , a.teriaL___ ---_�-:�------- Septic T : Distance from nearest well......:........_Distance from found-, Liquid depth__-h�- � ------------Capacity---- 0'a._.._-. Disposal • Id: Distance from nearest well___________ Distance from foundation__/�? Distance to nearest lot Number of lines---------- __ Length of each line_.----__ - .. Width of trench._r�_ ___�______________ - �. may---- Type of filter material___ f . _ Depth of filter materia____. ___.Total length:__/_..____._-L_�--`__. Seepa it: Distance to nearest well-_ ^' - :Distance from foundatior�-G)_._lDistance to nearest tqf line _ Number of pits-________�___--______Lining material_FDC_e-_---Size: Diameter___-"/...---Depth__4 __'�__ � Cesspool: Distance from nearest well-________________Distance from foundation------------.---_---Lining material-------------------------------- IJSize: Diameter-------------`------- --------------- Depth----------------------------------------- ----Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------------____Distance from nearest building------:---_----------------------_.______- ❑ Distance to nearest lot line--------------------------------- ---------- - Remodeli �� Jr Remodeling and/or repairing {describe:-------------- >''0-- 't.� ------ �f -------------------------------------------- ----------•------------------------------ -------------------------------------------- ` _._ K - ------ -------------------------- ---------------- . u,. I hereby certify that I have prepared this application and that the work will be done in accordance with San"Joaquin County ordinances, State law,, and rules gulations of the�San Joaquin Local Health District. (Signed) = - ---- -------(Owner and/or Contractor) BY ------- --------- - -----------------------------[Title)---- ., (Plot plan, showing size of lot, loco ' of system in relation to wed, buildings, etc., can be placed an reverse si e. j k r� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -------------------------------_ -- - -- -- ---------•--------- - DATE-----l.l:r_it. �_�_�-------------------- - --------- REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------ DATE----- -- ---•------- BUILDING PERMIT ISSUED - ._------------------- ------ DAVE-------------------- Alterations and/or recommendations:-_+!._�L-)__1_49 ---------- ------------------------------------------- ."------- ----------------------•--------------------- -------------- , + ----tl-!1`.a-�C!-�-.-Gr1t-t��.+i1- -�-------------�---C--1-3•------------=-�--.----------�-----1---(-5,---.-----.-_--------------t � tt Ii ---------------------------------------------------------------__---------------------------------- ------------------------------------- ----------------- ------------------ FINAL INSPECTION BY:'.------y`'C_..- " -- ------------ Date------------q-- -G_/ .S SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street I i J Z Stockton,California Lodi,California Manteca,California Tracy,California F-P.C 13,