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FOR OFFICE USE: - ------------ ---.._ --- l._�..f APPLICATION FOR SANITATION PERMITPermit No, .--Ib - ------- -- a(Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permi-'to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. r JOB ADDRESS AND LOCATION = a/c LY-_( �jh W- 4 v� Owner's Name...-,-J'/.— 1'F't` .." . .._. Phone. -----------------------------------.. . -----........ ------- --------------------------------------------------------------------------------------------------------- Contractor's Name_.-----,------- -- ----------•--- ------------ -------------------- --------------------------------- ----------------------------- Phone---------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ...I... Number of bedrooms-3-_- Number of baths -----J_ Lot size -AP-b_- '__. '-;---------------------------------- Water Supply: Public system ❑ Community system ff-'Private ❑ Depth to Water Table _G© ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date....................) No New Construction: Yes g•<o'❑ FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet j Septic Tank: Distance from nearest well...-.________Distanc from foundationld_____________ Material___C_- No. of compartments..--- Size- � Liquid de th_._1_.. Capacity .V. ` Disposal Field: Distance from nearer well_.~- Distance from foundation__Zk_r.------Distance to nearest lot line_-�-,.-_-._ Number of lines----- _-- ------- ---.-Length of each Iine.o�Q..:-_.. - _-.Width of trench.--��-----.__--.-_-------- Type of filter material-_ -_o_C_ A-------Depth of filter material__/1-_------------Total length..._/' �----_._---------------- Seepage Pit: Distance to nearest weft__-------------------Distan om foundation-17-- ----------Distance to nearest lot line_.5�__,_-_- Number of pits--.. _....Z.,--____Lining material-----&'..0-/<_Size:.Diameter_.3,•�_'__------Depth....�.S.T-)--------_.._ Cesspool: Distance from nearest weld___.----.--------Distance from foundation_ ...Lining material----- ._--.---_----. ❑ Size: Diameter- -- - ----.Depth-- ------ ----------- - ---------Liquid Capacity. .------------------------gals. v, D Privy: Distance from nearest well__ ---------------------Distance from nearest building-------------.------------------- ---_-- 3 ❑ Distance to nearest lot fine --------------------------------- ---- - --------------------- Remodeling and/or repairing (describe:-------- ---- _------------ ------------------------------------------------------------------------- -------- -------------------------- -------------------------- --------------------------------------------------------------------_-------------------------------------------------------------------------------------._.... I hereby certify that I have prepared this applicati n and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regula s of f e San Joaquin Local Health District. r (Signed)------------------------------------- -------------------- ------ I-- - - /,nto ---------. ------- -- -. ..------------------------ ---...._(Owner and/or Contractor) (Plot Ian. showing size o-- to};-- -----------o- ---- ------- - ---------------------------------------- Title p n. g ystem to relwells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - �• -=---- -------------------- ------------------- DATE----- 1 .----- r... REVIEWEDBY- ------------------------------ -- ------------------- -- --------------- -------------------------- DATE---------- ---------------------------------------------- BUILDING PERMIT ISSUED-------------------------- --- ----------------- ----------------------------------------------- DATE----- --------------------- _ Alterations.aod/ r recommendations:_ .. C 1 -E '----- -• - ---------------------... ................... - -- - ------- -- -•----- - ----•--- FINAL INSPECTION BY:--- J.,... --- Date f %-- :: /-- 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 a-59 3M 3-163 F.P.Cp.