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F OFFIW S&. ------✓-------------2- - — ---- APPLICATION FOR SANITATION PERMIT Permit No. .. -------------------------�A T Duprm..+.) 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 AND LOCATION_.. ". ?__ ------------- L� ------ -GE.----- Owner's Name------- ....... Phone.- � Address -----•--- � p-2.= ` Contractor's Name_. /&T - .. Phone - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms _ z-". Number of baths _/-..- Lot size ...L�l.-_61 -------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table4�. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date 47: V. No ❑ New Construction: Yes P No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticTank: Distance from nearest well S7'. Distance from foundation .-.-._.."_._.__-.Material ^Y� ` --------- -------- ET, No. of compartments-- v_._-Size-_ ."�"?._X �.__Llduid depth -. .� ..-_---- p Caacity�� ( ' Disposal Field: Distance from nearest well_ "- 0._Distance from foundation._../-10....."..Distance to nearest lot line...... ...... Number of lines-------- Length of each line-A D.;_ 6- Width of trench._. a i ... Type of filter material-_., of filter material-...-"-/,'".-_...Total length_---.. _ ..- Seepaoe Pit: Distance to nearest well----L _..--Distance from foundation--Z/.-.P/.-...Dista ce to n9arest lot line----- Number of pits-------/------------Lining material" ��.-__.Size: Diameter-. ..-"...--.--. J vj—K Repth----- ...a_._.._. Cesspool: Distance from nearest well------ -----------Distance from foundation Lining material-- ....". C t --- ElSize: Diameter--------------------------------------Depth----------------------------------- - ---Liquid Capacity----------------------------gais. Privy: Distance from nearest well------------------------------------------------Distance from nearest building _""-"--".-- ❑ Distance to nearest lot line--. . ..-.._."- Remodeling and/or repairing (describe)------------------- -----------------------------------------------------------------------::---------------------------------------------------------------•------------------------------------•-------•----------------------------------- 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 rules and regulations of the San Joaquin Local Health District. (Signe---- ezl/z ?1 (Owner and/or Contra B • Y• --------- 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-.--- /-,--------�.--��v�� b' ------------------ ---------------------------------------- DATE----------�1��..d;�2----------------------- REVIEWED BY---------------------------------------------- ----- ------ DATE----- -- -----------------------------�---------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- 4-------- -------------------------- DATE_ Alterations and/or recommendations••_ �� tZ - 'lit -� .a�---- ---------------- ------- ---r --------- ---------------- ------------------------ --- ----- --------- -->r r` -�---------- � :: -------- -- -- _ FINAL INSPECTION BY:..s/��(-------- 1----------------------- Date------- // 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.P.CD.