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LL� FOR OFFICE USE: F " =-"-------- ►--------------------- f 7 a }-_.--. --_---"_---_." APPLICATION FOR SANITATION PERMIT Permit No. 4�__. ...--__-- *. (Complete.in Duplicate) Date Issued--------------------A. __ ----..------------------- r This Permit=Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance i h County Ordinance No. 549. F �Z JOB ADDRESS AND LOCATION Owner,.S::Na e_ ---------- -. -- Ph one l Address =*" ,�: - �; ---re-- '---= _ ' I ' -------- I Contractor's Name = - ---- ------------------- Phone '.. 1r1 Installation will serve: -Residence Apartment House I] Cominercial ❑ Trailer Court C3 Motel ❑ Other; ❑ Number of living units: - �:___ Number of bedrooms Number o aths "_/__ Lot size __ � -�Z. s-- ------------------------- { Water Supply:'.fubliclsystem ❑ Community system ❑ Frivate _Depth to Water Table _______ ft. Character of-soil to a depth of 3 -feet: .Sand_❑ Gravel ❑ Sandy Loam F] Clay Loam [I Clay ❑ Adobe C] Hardpan L Previous Applica}ion Made: {If yes,date.-- .... ❑.._ -) No New Construction: Yes ElNo El FHA/VA: Yes E] No E] `TYPE OF-INSTALLATION-AND-SPECIFICATIONS - i, Nose t}c tank#or cesspool permitted if public ewer is available-within 200 feet.) p � P - P P P -" ' -----.Material--------------- ------------------------ ------ �. . ❑ No. of compartments.------- ----- Size------------_ _-�--:--_------ �1L quid'd'e"`th_---3`--------- --Capacity p P Y Se tie Tank: Distance from nearest well_______________ Distance from foundation _.7. � f f Disposal Field:� Distance from nearest-well___. ...__./Distarice from foundation_________ ________.Distance to nearest lot line----------------- ❑ Number of lines- -------------------`----- --Length of each line-----------------------------.Width of trench-----.----------------------------- 4 I k .Type,of filter material-=-------I----=� -.Depth of. filter material------------- -------Total length---.-----------.-:--•-- ------ --i-•---- Q , Seepa Pit: Distance to nearest well----- 0-e--_------D,istarlce f J&ndation___. -9_�_____--Distancelo nearest lot line__.S---------- _ . Size: _ __- 2,5 /, -Diameter -- Depth------ - --- ------------Number of pits..-'...... ---.--""--Lining mate-nal-____ Cesspool: Distance from nearest well______ _________Distance_from foundation-:..________._.__..Lining material------_---------_-_ ---- ---.. F Size: Diameter..................... -------Depth----= -- -------------- -----------------------I Uquid Capacity - gals. J � Distance from nearest.buildin Privy: Distance from nearest welL_ _----- --------' :. ------------ �3 - - ------------------------ ❑ Distance to nearest lot Eine--------------------------------------------------------------------- �`[ Remodeling. lung escn e : - --- i ---------------•--------------------- ------- -- �---- 6 _:--------------- 1 - - _ - ------- ----- ------------------------------------ - - �,.. I hereby certify'that I have prepared this application and~that the work will be done in accordance with San Joaquin County 'ordinances, Sta laws, and rules and regulations of the San Joaquin Local Health District. w r orContractor)(Signed) - --- ------------ T_-------- e)_ E (Plot plan, s owing size of lot, location ,of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y --------- - DATE l-� r °s -£"- REVIEWEDBY-------------------------- ---- -----------------------------------------.-,. DATE-------- -------------------------------------------------- BUILDING PERMIT ISSUED----------------------------- ---------------------- ------------------------------ ----------------- DATE-=------- =--=--------------=------------------------- .. Alterations and/or recommendations---------------------- ------"------- --------------------------------- ------------------------------------------------- ---------- ------------------------------------------------------- -------------------------------------------------------- FINAL INSPECTION BY:._ Datep --------------------- ------------ lr 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 B-59 3M 3-'63 F.P.CO.