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F R OFFICE USE: - ----------------------- ------------------ _______________________________________ APPLICATION POR SANITATION PERMIT Permit No. ... ------------------ -- - - (Complete in Duplicate) '} This Permit Expires 1 Year From Date Issued Date Issued ._..._1� J ------------------ t� /// 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. y Z107 JOB ADDRESS AN9LOCATION 1. ceSG ------............... � ,h �'-• -----j-------------------- Owner's Name.... - D---•---�, -------------------- ------------ Phone-------=------------------- Address------------•------------- �� -.1.112-ijogt�?p Contractor's Name. ----- d •-•----•--•----•---------•-- ------------•---•----------------------- Phone----•• --••---••••-......••-_..... Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .__ Number of bedrooms.-- _. Dumber of baths _ __ Lot size �l� �-�_-_-_--____-_--.---_--____-- Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table ........ ft. / Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand am ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ 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_________________Distance from foundation-----_--------------Material.------------------------------_----------------- V, ` No. of com artments__________________________Size____......._.__________..___._ Liquid de th_________-_-_-__._________Capacity _X Ai --------- Disposal Field: Distance from nearest well_________________Distance from foundation-----...............Distance to nearest lot line................. j�x❑ 1,/ Number of lines-----------------------------------Length of each line........________--_-_...-____-Width of trench----------------------------_...... / / Type of filter material----------_--------------Depth of filter material-----------------------Total length.......................................... Seepage Pit- istance to neare well______ _____________ istance fr=�ff and t'on/D.. ---.Di nce to nearest lot line /__._ r Number of pits_. Lining material.j� ¢e: Diameter- `!- -----Depthe.lf,�-��.0 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----_---------------.-------__--_________- ❑ Distance to nearest lot line--------------------------------------------- --------------_--•------------------------- -------•----------------------------------- LA Remodel' g and/or repairing (describe):-------., '�� ✓CAor �. ,, � 1 ►----------------------------------->,-.•---......................----------- --------- ---------Z-•--------------------------- ------ --------------------- ---------------------------------------------------------------------------------------•••----------•-------------------•------------- - .......-----------....... ---------------------------- I hereby certify that I h repared this lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, an ules nd reg io the San Joaquin Local Health District. (Signed)_______________________ ... ___ _ (Owner and/or Contractor) r y� By:............................................ ��' -{� ----------------- - (Plot plan, showing size of lot, loc i of-system in.-relation to.wngs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•---------------------------- - --------- -------------------------- DATE---- 6 REVIEWEDBY_---------------------------------_---------------------------- --------------------------------•--------------------- DATE. /r� BUILDINGPERMIT ISSUED--------------------------------------------------------------------------- ---------------- ---- DATE------------------------------------ Alterations and/or recommendations:_______ ------------------- ___ ------- ------------- --' ,/l� .1, A- -----------------------------------------------------------------•----------------- -----------------------------------•-----• ------------- ----------------------........----------............-----------------------------------------------------.................................... ---------------------------------------------------------------------------- ...............-..............----------_----------•.......----•-- -----------------•---•----------=--- --------------------------•--------- --------- -``------ ------.---•--••------------._.-.------------------------------ ---------- ----l--------...-------------------------------- FINAL INSPECTION BY:. Date------/S - S JOAQ 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.M130.