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FOR OFFICE USE: -R, �----------- a ----------------- -- ------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. -- f°� �� ------------ ----------- `3�._._. (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 ins: II t work herein described. This application is made in compliance:with Counfy Ordinance No. 549 JOB ADDRESS AND LOCATION_), _ Y - -- 7 �'wr ---- ---------------------------- r Owner's Name . = �:.._ - Phone��: = = ------ --------- �7 G_..---- 4 i ... l Address-...•-•--------------- Contractor's Name._ .... ._ r ry Phone.. Installation will serve: ;Residence Apartment House ❑ Commercial ❑ . Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�___= Number of bedrooms __-- Number of bathsI__-- Lot size "7J__"". -------------------------- Wafer -----------------• "---•Wafer Supply: Public system ®Community system [I Private ❑ Depth to Water Table " 55_ ft. { Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam C] Clay Loam ❑ Clay ❑ Adobe (Hardpan ❑ _ Previous Application Made: (if yes,date...:"...............} No [t' New Construction: Yes �No E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within{200 feet.) � -- i 1� � Septic Tank: Distance from nearest well___.__.'^--_-Distance from foundafion_�i0___-__"_.__..,Material_/_ __.__._._____. iSize___ --._--Li Liquid de th__.__j_No. of compartments Ca aci Q-0 r Disposal Field: Distance from nearest well----"___-----Distance from foundation O.__r_:__-_-_Distance to nearest lot line__s5_____/.... Number of lines----Y,--------------------------Length of each line---- _S._____�-----------Width of _ _ tren ch...-2-.�----------_-_------- --- 7 e of filter material _A_�__ -------DePth.of fltermaterial_ _k------I-----Tota length__ / SO _/ Seepage Pit: Distance to nearest well._ __-_-___._._":Distance from foundation_-/4"_........Distance to nearest lot line_ ____....-_ Number of pits_-�--------------Lining material_�_ �<_ Size: Diameter-----3 ----Depth----- 9�_ _____________ Cesspool - � a Distance from nearest well----------------- Distance from foundation--------------------Lining material"""__.._.____-"-_________"_-_._____- ❑ Size: Diameter-------- ------------------- -------- Depth-------------- ----------------------- -------------Liquid Capacity----------------------------gals, I Privy: Distance from nearest.well-----------.--------------------------------------Distance from nearest building---------------_----------------__.----_-- ❑ Distance to nearest lot line------------------------------------=--=--------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)-------------------- -----=----------------------•------------------------------------------------------------••----------------------------------------- ------------------------------- ------------------------- ----------------------------------------------•---------------=------------•----------------------------•-------------------------------------------------------- Y -------------------------------------------------------------------------------- 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, a d r es and�gulations of the San Joaquin Local Health District. ; �� (Signed)------------- --- X-0 --•---------------- ------------- ------- -------------------------------- -- ----------------------------' -----(Owner and/or Contractor) By:-------------------_- ---------- --- -------- ----------------------------------------------------------------(Title)---------- ---------------------------------- ---------------- (Plot plan, showing size of lot, location of system in relation to wells,,buildings, etc., can be placed on-reverse side). I a FOR DEPARTMENT USE ONLY -APPLICATION ACCEPTED BY_.L-:4 ..........._..___.-- - -------- ---------------------------------------------- DATE---7/il 3/6-K-------------------------- --- REVIEWEDBY------------------------------------- ------- --- •------------------------ DATE---------------------- ------------------------------------ BUILDING PERMIT ISSUED------------------------------------------K----------------------------------------------- -------------- DATE-------- -- --- ----------- - ------------------ ------------- �`_ y---- 4-_--= Alterations and/or recommendations:. .. ......... . ------•••---------------------------------------•-------- --------------------------------------------------------------- ------------------------------- - ---------------------------------------------------------_------------------- ---------- - ------------------------------------------------•---------- ---------------------------- --------------------------------------------•----------------- ----------------------------------------------------- ---------------------- -------------------•-------:---------- - ------------------------ Date_��` f� FINAL INSPECTION BY-.-( - ---- ------- ------------------------------------- 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 G5 9 REVISED a-59 3M 3-'63 F.P,120.