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FFI FO CE USE: y _ ' -- APPLICATION FOR SANITATION PERMIT Permit No. ------------ ------ - ------------------------- DuPlicaite] - -------------- {Complete in Date Issued _F//-/ �.�.. _--.- -_.._.__ 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 AN LOCATION-----'��---- --�..4J -------------- -�.,�IL0.nC A-'L .04 A77."— -0 -- - J ----- Phone------------------------•----------- Owner's Name---------- - - -- - - --------�1--------------- � -- Address----..'�--135� = ''4 ---------•---------------------------------------------•-------------------------------------------------••--------- Cantractor's Name C� Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --l— Number of bedrooms __ Number of baths -AL- Lot size -__I _-3,3 Q Water Supply: Public system Community system ❑ Private ❑ DepthtoWater Table 10- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ej—Hardpan Previous Application Made: (if yes,date--------------------) No IrJ New Construction.: Yes g?"'No ❑ FMA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic Tank: Distance from nearest well____ _________Distance from foundation_/A------------.Materiai---__L"`- �-`---- e (0 No. of compartments--------:7-------------•-Size------�JCa -47---Liquid depth----%-----.------------Capacity--kGp --- Disposal Field: Distance from nearest well--_--_.---__Distance from foundation_/q_____________Distance to nearest lot line__:i;77_ _____- 2T/ Number of lines_____________ ___ Length of each line---to_ .--_.____---_.Width of trench..z` ------------------------- Type of filter material___._ ___4_G_ . _Depth of filter material_____ i-_��__-----__Total length____140________________ --------- - . f ------------ � �r n, Seepagj-Pit: Distance to nearest well___'_`------._.___Distance�om fo�undation_Ld---_____......Distance to nearest lot line��____-_____ Number of pits------4Z-----------Lining material-____��'-6-G__L--.Size: Diameter---� _- Depth----- _'----------- -•--- Cesspool• Distance from nearest well-----------------Distance from foundation--------------------Lining material____..______--______._--________.__. ❑ Size: Diameter------ ----------------------- ------Depth---------------------------------------------------Liquid Capacity-. Privy: Distance from nearest well------------------_-------------------------_-_._Distance from nearest building-- --________-_________-____-_--__.___. ❑ Distance to nearest lot line----------------------------------------------- -------------------------------------------------------------------------------- ---------- Remodelingand/or repairing (describe)------- --------------------------------------------•--------------•--------=---------------------------------------•------------------------------------ ---•-------------------------------------------------------------------------•-----------------------•---------------------------------•-----------------:--------------------------------------- ------------------------------------------------------- --------------------- -------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------•-------•---------------------------------------------------------------------------------------------------------------------------------••-------------------- hereby certify that I have prepared this applicati n and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulat' s of a San Joaquin Local Health District. (Signed) ------------------------------- --------- -- --- ------ - -----------------------------------------------------------------------(Owner and/or Contractor) By:---------------------------- -------- ------ - --------- ----------- --------------------------------------------(rt le)-------------------------------- -- ------------- ------ 0 plan, showing size of lot, locatto -sys em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY "---------------------------- DATE------------------5 ..1 .----�`�--�--------------- y REVIEWEDBY-------------------------------- ----------- --------------------------------- ---------------------------- ------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------•------------- -------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations a /or r ommendatio --------------------------- ------ ----------------------•--------------I--------------------.�------------------------------ ,pd ------------------- .. - -ter --------- ,/ � ------------------------------------------- --------- FINAL INSPECTION Date--- --------- � Z- 5 ------------------------------- 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 8-59 3M 3-'63 F.P40-