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FOR OFFICE USE: / ------------------------------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. �1..._ - -------------------------------------------------------- (complete in Duplicate) Date Issued --- -------- --------- This Permit Expires ! Year From Date IssuedG�.� 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. �¢��,j s �'7- Z2c�-- 07 <2(0 2,2.2- /J- r t_L--r d 1-7-40 - - JOB ADDRESS AND LOCATION....-- ,Cr -r'''t_'+ - ---------------- ------•------------------------------------------- Owner's Name----- ....... ----------------------•--------•---------------------------------------------------------------------- Phone------------------------------------ i 13r _Y�— 4.------------- ---- 414 Contractor's Name-AY.".� X � -%�!"r. ----- =---- �-90f -- frkione.._ ! r-3• - .? '. Installation will serve: Residence ® Apartment House E] Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-1-----`Number of bedrooms _ __ Number of baths Lot size -- ---------------------------•-------- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table _?__ ft. Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam El Clay Loam to Clay ❑ Adobe❑ Hardpan, Previous Application Made: (If yes,date- -----------------1 No ?] New Construction: Yes fl No ❑ FHA/VA: Yes ❑ No El N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I ` N Septic Tank: Distance from nearest well_---Sb------Distance from foundation_..-I_p----=-_-__.Material--_ t� ! �"---- -----------•-• 11D No. of compartments...1%..............--------SizehA4Q_'4j_%&Liquid depth------- ;L---------Capacity__!_ .-------- Disposal Field: Distance from nearest well----4__0-------Dista ce,.from,foundation-----_--0_�...--.Distance to nearest lot line_----------- Number of lines--------- -------------n------Length offeach line----------�r ;f ------Width of trench `` f---------------------- T Type of filter material' '._ ----Depth of filter,material-----��--------------Total length---- _0-0-'------_----__.-_.------- Seepage Pit: Distance to nearest well---.--.- ---------Distance from foundation-----la_..__-_.--.Distance to nearest lot line--.P p M Number of pits-_.----—-----------Lining material_Pq�'r--------------Size: Diameter-----. ...-........Depth---?n. -------------.------.--- Cesspool: Distance from nearest well---------_---.--Distance from foundation--------------------Lining material---------------_----_----------.--.-. ❑ Size: Diameter--------------------------------------Depth------------------------------------------- ------Liquid Capacity----------------------------gals. ---------------Distance from nearest building i Privy: Distance from nearest well--------------------------- ----- 9-- ----------------------- --------- - ❑ Distance to nearest lot line-------------------------- ----------------------------•------------------------------------------------------------------------ Remodelingand/or repairing (describe)=-------------------------------------- -----------------------------------------------------------•------------------•------------------------------- ------------------------------------ ----------------------------------------- ------------------------------------------------------------•-------------------------------------------------------------- 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 r gulations of the San Joaq 'n Local Health District. (Signed)---- --------- � � -- ---�'� (Owner and/or Contractor) By:----------�-- -:_ s '------------------------------------------------ (Ti+le] � (Plot plan, s�ing size of.lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � � ±'°A�.+ ----------------------------------------------- - DATE REVIEWED BY-------------------- ------------------------ ------- --------- ------------------ ----------------------- DATE - BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE---------------------------------------- ------------------- Alterationsand/or recommendations----------------------------------------------- -----•---------------------------------- -----•--------•----•----------••-------------------------------------- -----------------------------• - E f _ n 7 - ---------- ----- -----wtf, ------ - '' -- ----�'--- � --`------------- rA - �: f --------•---------------------------------- ------ ---------------- •------------------ FINAL INSPECTION BY;ed:�_y--------- ------------------- Date--- =j. _ ------------------- ----------------------------- 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 ES 9 REVISED 9-59 3M 3-'63 r-P-120. 1