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.FOR O�FICE �SE: — --------------------- _-.---_---------.----------------- APPLICATION FOR SANITATION PERMIT Permit No. _A?j946, --------------------- - -------------------- -- -- -- (Complete in Duplicate) ------------ --- 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. JOB ADDRESS ANj�LOCATION.- Owner's Name__:: .;.G 4d,._---- ------ ----------- ----- Phone- ---------------------------------- Address---- Contractor's ----- - ----- ----------------------------------------------- - Address--- �------ - - - ------ ---------••--•- Contractor's Name__6Z11 __ - _ �(p� j"",/z- ------ - - Phone --------------------------------- Installation will serve: Residence [}4Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: Number of bedrooms __ _- Lot size .__!4__�_ __.2-S__ ,�- --._ Number of baths _� Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 7 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan El Previous Application Made: (If yes,date--------------------) No —New Construction: Yes ❑ No P9-1"FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tiA distance from nearest well-----------------Distance from foundation__.---------------- Material_____-__..._______-____...__.____.___._____._. No. of compartments----------------- --------Size--•-----------------------------Liquid depth- Capacity-----------------------\ i A Fieid: Distance from nearest well________________Distance from foundation-_-------------------Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line------------------------------Width of trench------.---------•------------------ Type of filter material------------___----------Depth of filter material--------------------.--Total length--------------------------------- _;----- i Seepage Pit: Distance to nearest well _ Distance om f undation-----9_........Distance to nearest lot line----_vr.---------- Number of pits.__.--�-------------Lining material_ 0.4'le-_ Size: Diameter------ --a- r, ---------Depth-- - �--+�-------------- •-. 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--------------.-----_________.____._.___. I 11 Distance to nearest lot line-----------�-Q ----------------- - --------------- ------------------------- --• ---------------- --- - �-------------- ---------- Remodeling and/or repairing (describe):__/ ---ll---------- -----1-----•----------- - � -- ------ v ------ ---••---- -- ----, Y ------X44-------------- -------/�-_--- ---------------------------- ----------------------------------------------------------------------•------------------------------------------------------- ----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Counfy ordinances, to laws, and rules and egulations of the 5 n Joaquin lzacal Health District. ' k (Signed)._____ ------ --___ ------ wner and/or Contractor) gY � c- ' -------------------------(Title)--- _ . .. ----- . ----- (Plot plan, showing size of lot, location of system in relation f- wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY.------------------ ``r ---------------- DATE_ - REVIEWED BY------ --------- -------- --- --- DATE BUILDING PERMIT ISSUED-------------------------------------------------------------------------- ------------------------- DATE Alterations and/or recommendations:-----------=-------------------- -------------•-------------------------------------------------------------------------- -------------------------------------------------------------- -------------- -------------- ---------------------------------------------------------------------- --------------------- -------------------------- --------- - ------------------------ ---------------------------- .............. ---- ---- -------- - ---- --------------------------------- ----- ------ tj FINAL INSPECTION BY:----.-----� -------------------------- ----------- Dafie.----- ----------------------------- SAN JOAQU.IN LOCAL HEALTH DISTRICT 1601 F.Haxelton Ave. 300 West Oak Street`;; 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F'.P.CO.