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FOR OFFICE USE: �¢P ------ - - Permit No. �'.C `------ APPLICATION FOR®SANITATION PERMIT - ----------------------a---- ------------------- (Complete.in Duplicate) Date Issued �� -------------------_.____.__._...--..--._.___,____.._-. This Permit Expires f 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.-4L made in compliance with County Ordinance No. 549. .A, / r. /yam /) �- � fi -----------•-----_ - __"�' - _ _ __ __ _ "T�"___ -------------------------------------------------- JOB ADDRESS AND L TIO � !! Owner's Name �G --------- --------------------------- Phone Address------------------------ ---- ----- ---------------------- Contractor's 7 a -•--.... 'r ---------------------- Contractor's Name--------- --------- - ----------------------------------------------------------------------------------- Phone ----- Installation will serve: Residence partment HouseCommercial E] Trailer Court ❑ Motel C] Other E] Number of living units: _____ Number of bedrooms-- Number of bath-- Lot size _________________________ Water Supply: Public system ❑ Community system rivate ❑ Depth to Water Table,,�47ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑ Previous Application Made: (If yes,date_.._. ............l No Q,/New Construction: Yes No ❑ FHA/VA: Yes E1'-1To❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well---s� -----Distance from foundation_�f a_____________Ma�riai_C-C_.e_�� No, of compartments Size___ __ -0 Li uid de th___ t Capacity .�--- �• P -------- ---------------- - E? y- -?..� P Y Dispoosa/l field: Distance from nearest well__.!__--Distance from foundation__ _ Distance to nearest lot line-.d ______ ' +� Number of lines- .12— of each line.*,�_> ____.Width of trend Type of filter material___ ._-Depth of filter material ----------Total length_./ _ _ __---_____________'______-_. SeepageIt: Distance to nearest well_/-M__f___ Distance from foundation__ A_Q__ to nearest lot lines�!___._--_ m ------Linin material---_ bL. --- �- 6/_----De th_t��`(-___- I" Number of pits_.._ _�..- g _.Size: Diameter. p �'`��-j/--- r i l Cesspool: `Distance from nearest well_________________Distance from foundation-------------------Lining material--------.._._____-__________________- ❑ Size: Diameter--------------------------------- -- -Depth---------------------------------------------------.Liquid Capacity----------------------------gals. Privy: Distance from nearest Well----__--------------------------------------___Distance from nearest building--------------------------------------.--- ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------- ------------- -------------• ------------------ -------------------------------------------------=•-----------------------------•----------------------•----•---------------•--•-------- ----------....--------------------------------------------------------------------- ----------------------- -------------------------------------------z I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State 1 jawriv and rut d regulations of the San Joaquin Local Health District. (Signed) Owner and/or Contractor _= (Title) (Plot plan, showing si e. lot, loc�sys+elation towells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- -'- . .-. ----------- ---------------------------------------- DATE---------/-0'-1�2-161R------ -- REVIEWEDBY--------------------------------------------------------------- --------------------------------------------------------- DATE-----------•----------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------- -------------------------------- DATE------------------------------------------------------------- i Alterations and/or recommends io --- --- ----------------------- .3-------------- x.31 ` `�" -----°A-�- - - f � n------------------------------------------------------------------•-- ----------------- --------------------------------- 44 - - --- ---------------------------- FINAL INSPECTION BY:-------- /c��'--------------------------------- Date-- ----� - 9/-6.3------------------- --- G 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 s-59 3M 3-'63 F.P.CC.