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Ijf-FICE USE: --- f - -------- ------- --------------------- -- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. .��1. �- -- . (Complete in Duplicate) This Permit Ex fires11 Year Fr am Date Issued Date Issued /a,-/_ _ Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install work herein described. This a plication is made in compliance with County Ordinance No. 549 JOB ADDRESS Owner's Name----------' -..---- -�.E -.�----- - --------------- •----- Ph- ----------------------------- - Address---- Contractor's Name - - ------ ----- i ----------•------------•----- -------------------------------------------------- --__ _ '� - --------------------------------------- Phone.------•--•----------•--•---------• Installation will serve: Res':dance ��,� Lr�:: apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:._ -_ Number of bedrooms _ ,Gi Number of baths _---_ Lot size __.____ Water Supply: Public syst rn ❑ Community system ❑ Private Depth to Water Table M__ ft- F Character of soil to a depth of 3.fee:'.Sand ❑ Gravel 0 Sandy Loam ❑ Clay Loam ['Cla ' �� y ❑ Adobe E] Hardpan E]Previous Application Made: (If a-s;date.___t -N---_.-- r - ) No New Construction: Yes ❑ No [�yFHA/VA: Yes ❑ No 0 � TYPE OF INSTALLATION AND SPECIFICAT ONS {— (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well----------- ;__Distance from foundation---.. -Material--------------------------------------------------- L f 1��' No. of compartments_ '` '.Size-. -- Liqui ---_._--_-:- . d depth-------------------------Capacity------------- -----� °p i D�spos�l Fieo: Distance from nearest well-----------------"Distance from foundation--------------------Distance to nearest lot line------------------ �. !� Number lines---------------- ----------- -Length of each line--------_---------------------Width of trench--------- ----- Type-of fiiter_material -----_.,,-__---- F -1 Depth-of _filter material-----------------------Total length------------------------------------- Seepage Pit: Distance to nearest well--- Distance` om fo. ndafion--_ ry / -..-- Distance to nearest lot line--- ------------- Number of pits._.-- -_--- _Lining material-- Size: Diameter-__ �� t rrr•l - De tn_ Cesspool: Distance from nearest well-----------------Distance fro\M'El I foundation__-.--_---.__-.=_.Lining material--_.---_-____-.--__.--__ i ----------- Size. Diameter --- - _ p - ' == Liquid Capacity T gals. Privy: Distance-from nearest.welj------------.------�_ - Distance _ from 'nearest building---------- ------------------------- Distance to nearest.lot line____________ � _______ _ = ----- - Remodeling and/or repairing:(describe)---- -----` €•��*��t-a .�A ' - 3 --__-__--_--•-----------------•__---_-_-_--•----------------------•---- -------'..---------------------------------•-----•---------------------------- --.- -------------------------I---------- -----------•------------ •'k- - i - ------------•-•--__-.-_---------_-----.-_-_-__----------------------------------------•---------------------------------------------------------------- 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, and rylles and regulations of the San Joaquin Local Health bistrict.',. (Signed)-----------------` i -----------------------------------------------Pr Contractor) By:-------------- ----------- ----------z '�{� -------------•----- ( P g e)... ........ ----------- FOR Ian, showing size of lot, location of system.in a}io`ri to wells,.buildings, etc., can be placed on reverse:side). . . , w �. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -----_-- ------- �3--/ REVIEWED BY----------------------- DATE �- ------ -------------- - -----. DATE-------------- �----------------------------------------- - - ILDING PERMIT ISSUED----------- DATE-----•---------- ----------------.-- --- Alterations and/or recomm dations:'------ -------------- --- -- W �� 1 , l -- 3 - ----- � G ;; -------------- ---------- r ef ---------- ,. - ------------- ------------- -------- ------ ------------- t r ------------ -- FINAL INSPECTION BY:.... =; n. f --- --9-' --------- -- ; Date--.--- --- --- • - AAN;JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street ' r �,. «~.:;..� 124 Sycamore Street- 2p5 111�esj gift Street Stockton,California Lodt;California iVianleco,California Tracy,California ES 9 REVISED 9-59 3M 3-'63 F.p,D D, n