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FOR OFFICE USE: F --- - --------- ----------------------- i _ ________ ___ ---____-----------II,.-____-----.--_-------. APPLICATION FOR SANITATION PERMIT Permit No. ._ .. � �I (Complete in Duplicate) �/ j 6 --- --- --- This Permit Expires 1 Year From Date Issued . 1 Date Issued __7.1,-1 ...-.T Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatiok is made in compliance with County Ordinance No. 549. ; C�CyS-1Sin�i{2_ 3 `S2 a - � �5'c7. /deo JOS ADDRESS AND LOCATION._'!' '�1 -1�r6-------- -.-�aar�r-- ------- —_-_1��- ------------•---------- s � /.. .. Owner's Name' = �!� ------ l ----------------------------- -------------------------------------- -------- Phone.-.------ •----------.------------- Addressill °Z �3c`' ` '• -- - -------------------------------------•------------------------------------------•---------------- Contractor's Name-- i-� -------------• ------------------------------------------------------------------------------------------------------ Phone----------------------------------- Installation will)serve: Residence Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number lof living units: ._.--_ Number of bedrooms -- Number of baths Lot size _-1A,.,----------------------------------------- Water Supply. Public system ❑ Community system El Private F1 Depth to Water Table --_--__ ft. Character of sbll to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan-® Previous Application Made: Ilf yes,date...-- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ f TYPEOFINSTALLATION AND SPECIFICATIONS: __,(N o septic tank or cesspool permitted"if public sewer is available within 200 ��a,� , Septic Tank: I Distance from nearest well-----------------Distance from foundation--------------------Material----------------------------------- --___----_---. ❑ s No. of compartments--------------------------Size---------------------------------Liquid depth----------- -- -----------Capacity-----------••---------- spo"�'a Field: I Distance from nearest well__..............Distance from foundation--------------------Distance to nearest lot line__-----.._--.._-- ('(7 ❑ Number of lines-----------------------------------Length of each line-----------------------_------Width of trench----------------------------------- Type of filter material---------------.---------Depth of filter material-----------------------Total length-------_----__-_-__-_-- -__--.___-.---.__- Seepage Pit: , Distance to nearest well.' ----- ------- from oundation__e_L_P_-_-__--_--.Distance to nearest lot line_--_----.-._ • 1 ! Number of pits---/----------------Lining material__/'. _------_.-Size: Diameter-_�4i-------------_.Depth----!��Z----------------.-.• N1 fr Cesspool: Distance from nearest well-----------------Distance from foundation___---------._____..Lining material-------------------------------------- 0 _.__________ -______-_-__________.__:❑ Size: Diameter------ -------------------------------Depth------------------------------------- -------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------............ ❑ Distance to nearest lot line----------------------------------------------------------Y -------------------------------------------------------------- V Remodeling a Id/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- ------------------------------------------------------- -----------------------------------l----•-------------------------------------------•---------------------------------------------------------------------------------------- Y ------- - .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. . (Signed) --•-----------------------------------------.--.------ ---------------------------------------------------------------------------------------------- [Owner and/or Contractor) � a BY--- ------------• --.: ---------•----= -------------------------------------------------------------------------------[Title) (Plot plan,.sh41ng size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). Il. :�P A FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY --------------------------------------------------------- DATE__ `31 REVIEWEDBYlk' -------------------•- -------------------------------------------------------------------------------------------------• DATE------ ----------- BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations--------------- ---------- ------------------------------------------------------------------------------------------------------------------------------------- ip ------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ •------ -------- ------------------------ i ------------------ --------------------------------------------- FINAL INSPECTION SYK_1. /.. - -------------------- Date---=1_.---- --.- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 1;Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street stock l`on,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-•63 F.P.00. .Ili d i