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FOR OFFICE USE: ----- - -----------=------------------------I---- --- --- // 57 ----- --------------------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. . 1l- _ (Complete in Duplicate) IdI30 _ This permit Expires 1 Year From Date Issued 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. OZ3 15'35-.- "J' A JOB ADDRESS AND LOCATION_-- __-__,, ----:----- �i �' 7 Owner's Name--------f_i�` 1�-- fs! ±-----------to&�� Phone------------------------------------ ----------------------- Address----------------- ------_!-!------- &A-----IA_?........... *[-`----------------------------------------------------------------- •--•- -------------------------------- Contractor's Name__.A1_ZA—_ -_—A---— --------------------_------------------------------------------------------------------------- Phone----------------------------------- Installation ------------------------------ -Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1_____ Number of bedrooms _3____ Number of baths A-____ Lot size ------/A77 ______________________________ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table tS.O__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam[j] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/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_47PP------Distance from foundation___ -is----------material--- ------------------------ No. of compartments-------;"-c------------- -------Liquid depth------#---------------Capacity_`��'�?---------- Disposal Field: Distance from nearest well__�b__-_-_Distance from foundation._f 0__.________-Distance to nearest lot line--r.......... t� Number of lines---.--_1----------------- Length of each line__-f------------------.Wiclth of trench-��-''_-------_-----_-__._- Type of filter materia}'T4"-A.�!___Depth of filter material-----IR____`______Total length----- n__r___________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- "n ❑ Number of pits----------------------Lining material----------.------------Size: Diameter----------------------.Depth-----------------•------------.-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------.-_ f° ❑ 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):-----'24/ -----/4-....--- „1-.- -'----------- "`--�"Is'�-e---------------------------------- -----------------------------•--------------------------------•---------------•-------------------------------•---------------e ------------------------------------------------------ -------------------------•------------•-------------•-------------------------------------------- .........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,yandles and regulations of the San Joaquin Local Health District. (Signed,-- ---- --------------- ---------------------------------------------------- (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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -X/ ----------- ---------------------------------------- DATE---/19_7- ?_ . - -- --------------------- REVIEWEDBY----------------------------------------- ------------------------------------- --- -------------- ------•-------------------- DATE--- --------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------------------- ------------- Alterationsand/or recommendations:------------------------------------------------------------------------------------------------•-----------------------------•---------------------------- -- ----------------------------------------- --------•-•----------------------------- - ---------- ----------------------- ----------------------------------------------------------------------------------------------------------------------------------------------- ---------- ---------------------------•---------------------------------------------------------------- ---------------- ----------------------------------------•---•--- ---------------------------------------------------- FINAL INSPECTION BY: ....�z.�'21------------------------ Date --• --------- ...... --------------•------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.1laxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California E5 9 REVI5Eq S-59 3M 3-'63 F.P.Cq-