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FOR OFFICE USE: , --------------- --- /._.gip.. , --------------------------------------------------------- APPLICATION FOR-SANITATION PERMIT Permit No. r � --------------•--- -- ----------------- -- ------------ .- (Complete in Duplicate) Date Issued ---------------- - ------------------------------------ This Permit Expires 1 Year From Date Issued .,�=�----_----- 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. JOB ADDRESS AND LOCATION--- Wim. _._ r Ace-------7 �'- �%/ ---------------------- Owner's Name----- -----L /�- - -- ---------------- ------------------------ Phone Address------ ----------------------------------......-------------------------------------------------------...------------------------------------------------------------------------ it Contractor's Name ------ f- /'` f� ----------------------------------------------------------------------- Phone------------------------•--•------ ! Installation will serve:. Residence Apartment House,❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: __/__ Number of bedrooms - Number of .baths _`-- Lot size Z7AZ:6_4 A1� -----------••-------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tablea741074. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p''01C"lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------.-------J No Z?' New Construction: Yes ❑ No p-'FHA/VA: Yes ❑ No p,r. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu6lic sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- 1*16;1 0 No. of compartments--------------------------Size_.__..-------------------------- Liquid depth--------- ------ --------Capacity-------------- -------- df Disposal Field: i Distance from nearest well-lere----_-Distance from foundation__.�_ 49_'____.__Distance to nearest lot line_ ____________ 14t3 j, Number of lines._.---/________ _.. Length of each line__�� -----_.--------Width of trench_. __ _-------1-_______________ Type of filter material Depth of filter material__Z.4�2o------Total len th-. -__ Seepage Pit: Distance to nearest well________--------------Distanee from foundation--------------------Distance to nearest lot line_____.____-.___-_ Number of pits----------------------Lining material-----------------------Size: Diameter__.-----"-------------Dept h---------------------------_-.... Cesspool: Distance from nearest well-----------------Distance from foundation---.----------------Lining material__----_______________________________ ❑ Size: Diam'eter-------------------------- ----------De th--------------------- --------------- - Liquid Capacity_ gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest [�ilding-_______._______,----________..____-.__. ❑ Distance to nearest lot line---------------------------------------------- ---------------------------------------------------------------------------- ---------------- x ----------------------------------- f r Remodeling and/or repairing (describe):-- -=�•-------•---------•--------------------- � ------------•----------------n-----------------ti--------- - s � ----------------------------------------------------- -- * •-----• -----------------.---------------------- 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.. fi (Signed)------------------------- /{ --- - -------- / --------------------------------------------I�or Contractor) BY:---- -------------------------------------•------------------------------- `� '--------------(Title)-- Ww-t-------------- -- -------------- (Plot plan, showing size of lot, Icrcation of system i tion to wells, buidings, etc., can.be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - Y DATE g -�`'y REVIEWEDBY-------------------------------- -------------------------------------------------------------------------------------------- DATE------ ---------------------------------------------------- BUILDINGPERMIT ISSUED.--------------•--------------------------------------------------------------------------- --------- DATE------------------------------------------------------------ Alterationsand/or recommendations:---------------------- ----- -----------------------------------------------•---------------•-- -------------------------------- ---------- ---------------- -------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- -------------------------------•---------------11 ------------------------- •-•---------- -------------- --------------------------------- ------------------------------- ----------------------------------------------------------------•--------•----------------------------------------------- -------------------------- - ---------- -------- ----------------------- -------------------------- ---------------------------------- ------------------------------------------------------------------------------------- ------------------------------------------ •---------------------------- ---------------------------------------------- i 5? FINAL INSPECTION BY:- --- ----`-- '- -- - - --- ---------------------- - Date ...... ---- --P------^�- --- 7------- --------------------- •- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haaelfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California + Manteca,California Tracy,California 95 9 REVIBED 8-59 3M 3-'63 F.F.CD.