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FOR OFFICE USE: y- �---G -------------------------- --------- _.. 61k00-�------_.__.._--_- APPLICATION FOR- SANITATION PERMIT Permit No. ZM ------ ---------------------------- :. - (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 Ordijn*ance No. 549, JOB ADDRESS AND LOCATION...�_�/_��______�---------------------------- ------_-------yy Owner's Name - If .--T- ---- -- Phone----•------ - Address-------.s5�-..... a _ Contractor's Name----- U ( --------------------------------------------------------- ------ Phone Installation-will,serve:. .Residence:._ 'Apartment,House,❑. Commercial,❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units::_t-.___ Number of bedrooms _Z_ Number of baths I__,_ Lot size __7S____91 4 U______________________________ Water Supply: Public system ®community system ❑- Private ❑i Depth to Water Table _� ! Character of soil to a depth of 3 feet: f Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobe --Hardpan ❑ Previous Application Made: (If yes,date- --------------) No-n---New Construction: Yes [3--Ro ❑ FHA/VA: Yes ❑ No Zj— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted.if public sewer is available within 200 feet.) T _____Distance from•foundation_ Septic Tank: Distance from nearest well-_----___--- from'foundation-/O--- ---------------- No. of com artmenfs___- p �----------------Size--S.X_d ----------Liquid depth --'0....--..............Capacity_ Disposal Field: Distance from nearest well___---------_Distance from foundation--&------------Distance to nearest lot line____:_________. Number of lines__., Length of each line_::_ -_ - ---------------- ----- - - �`-----------------Width of trench----.2--4--l"'----------------- 4 Type of filter material_�l fa-C_�X-_Depth of filter material---- length ________________________ _ ® r 0_ ' a1 Seepa Pit, Distance to nearest well__~��.____Distance from foundation__ _______________Distance to nearest iine_______.___._____ � Number of pits------- Lining material__�Q_Cr�C_Size. Diameter._._3. ' .[,3-�� _ Deptn----- Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material______.------------------------------- 9 ❑ Size: Diameter------------------------------------- Depth-- --------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest wefl________________ __.______----------- ---------Distance from nearest building______________________ T ❑ Distance to nearest lot line--- ------ -----------------------------------------------------------•------------------------------------------------------------------ Remodelin and or re airin _ describe :_ _ _.:------------ ____________ _____________ .S r --------------------- -------•------------------------------ ---------------=------------------: ---------------------------------- ----------------------------- --------------------------- -----------------------I'------------- r ------.---------------------,.------•--- ---------------------------------'---------------------------------------------------------------•----•--------•--------- ------------__ I' - I herebyicertify that I have prepared this!application' and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ru . and gala+ions of the San Joaquin Local Health District. t (Sign ________ __ ___________-- -__ __ ---- ed) L: f -_(Owner and/or Contractor) ••-By------- --- - -------- --- ------------ i-----------------------------(Title)--------!--------------------- ------- - --------- (Plot plan, showing sl o lot, location of stem in relation to wells, buildings, etc., can be placed on reverse side). 7 - � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --1----- ------•------------- DATE - g 1' REVIEWEDBY--------------------------------------------- -------------- -------------------------------- DATE:__-•- BUILDING PERMIT ISSUED----------------- -------------------------------------------------- ----------------------------- DATE------- - Alterations and/or recommendations f ' -----------------•--------------------•-- -------- ------------------------------------------•----------------------------------- ------------•-------------------------------- ------------------------------------ ------------------------------------ ------------------------------------------------ --------------------- FINAL INSPECTIONBY:.r�.a.. rC Date.... -; 7 _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California` Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'53 F.P.CC.