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FOR OFFICE USE: ----- ------- ---------- `.�--------- - -4 . APPLICATION FOR SANITATION PERMIT Permit No. .2 ------ 7 - ---- ------- (Complete in Duplicate) - -------- -- This Permit Expires i 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 appiication is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION....�C.r 4' Owners Name----- *r _L� 'j -�........ _l.�1- --Q�.2l S'--- - - -------------- - Phone------------------------- - Address--------------------- fir~ : 1�_�1�.,� ] Phone.- CC1 Contractor's Name. _ - I. --�-i7 - 4-;------------------ -------------- _X6.1( _r�_. Installation will serve: Residen�cye/�partment House ❑ ommercial ❑ Trailer Court ❑ Motel El Other ❑ Number of living units: _fes Nu her of bedrooms __-_ Number of baths _ Lot size .-1.x.11 _ --)-t ....4---- ---- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table6oft. Character of soil to a depth of 3 feet: Sande ravel E] Sandy Loam ❑ Clay Loam F] Clay El Adobe Hardpan ❑ Previous Application Made: {If yes,date �.-. j No ElNew Construction; Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s wer is available within 200 feet.) Septic Tank: Distance from nearest well- . Distan fro f un a i �7� - ---.-_--Material-.-- Art No, of compartments-.. .[ Size.- . __- __Liquid depth_v ;.- -_- -„-_-_Capacity-f !¢- . D'spos I Dis}ante from nearest wellDistance from foundation..:-L4()__ _..-.Distance to nearest lot line__..-. ` Number of lines-----I__ -_Length of each line �i --- - �� Width of trench.- �.�---- ------ -- r }�—� Type of filter material Depth of filter material-.-.... To+al length.._/_ _.--"- "-_ ------------- - Seepage Pit: Distance to nearest well --------------- ----Distance from foundation------------------- Distance to nearest lot line....___._.. ❑ Number of pits-.- .-.---- -Lining material-- - - - --. -Size: Diameter------------- -Depth- ----------- -------- ------ Cesspool: Distance from nearest well-_--------------Distance from foundation----------_----__. Lining material-._____"------------_ ❑ Size: Diameter.__ ------- ----.. - .-Depth----- ------- -- --- - ------ Liquid Capacity -------gals. Privy: Distance from nearest well __--------------------------------- -”Distance to nearest lot line.-.. --- Distance from nearest building__ ----------- --------------- _ -------------------- Remodeling and/or repairing (describe):--- _ �^ /�/� J (�/f - ----- -- -- -- ------ --- ---- --------- ------------------ ----- - -------- 1 I. --------------------------------------------- ------------------------------------------------------------------------------------------------------ ---------------------------------------------- -- - - V► I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a las, and rules d regulations of the San J Local Health District. (Signe i I � -i -��{--- ------------------- ....... Contractor) By:------------------- - Title)------ ----- (Plot plan, showing size of lot, location of system in relation to ells, buildings, ------- ... ... .... . .. .... 9"'.. can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------"-- ✓.n' - ----------------- DATE------ _- 2/ - -------- - - ------------------------- EVIEWED BY----- -- ------- - ------ -- --- -•.... - - ---- ---- ----- DATE---- -" ---- - - --------------- ---------------------------------- - --- - --------------------------------- UILDING PERMIT ISSUED...................... -------- -------- --------- - ----------- - - ----- -------._ DATE..__..--------------------- -- ---------- Alterationsand or recommendations:---.--- -- "-.----.-_ FINAL INSPECTION BY: =` Hate----- / SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ffa:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 3M 3-'63 F.p,CO.