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F�ICE USE: t '3------ � - - � Permit No. .._�'.� ---- APPLICATION FOR SANITATION PERMIT -----4 _11 - -- (Complete in Duplicate( Date Issued .- �-- - i`'3 ----- ----- ----------- This Permit Expires 1 Year From Date Issued pplication 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 L ATION__ ___ __ //"// Owner's Name........ ------ •- y4l�' ------ ------------------------------------------- --------------- Phone ---,,�j Phone----------------------------------- Installation Name-----------1-4,16 K�-------- ---------------------------------------------------------------.._.----------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ /Motel ❑ Other ❑ Number of living units: _.C�/_ r of bedrooms Number of baths j_.__ Lot size ___ t , ------------------_------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table- 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------------- No New Construction: Yes No E] FHA/VA: Yes E] No 4 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 f° 'dation a--- - iaO rlal_� ,e -----ty4wl----_------------ Septic ----•-•- x'`� jJ----Liquid de th__7los�-----------Capacity- ----------- ----- No. of compartments---- ------------` Size q i? D.r-__.Distance to nearest lot lune. .. Disposal eld: Distance from nearest well. I Distance from foundation._.,._ -__ nth of each line_______ ____ Width of trenches .....C� Number of lines___-______,�___-`-_-_-__-___--- 9 O i -- Type of filter material_. ,�J- dC ___Depth of filter material___ __ ___________Total length___--___ _.___........__...._.._�. Seepage Distance to nearest we from foundation__/0_..__._..Distance to nearest loth--- Linin material__. L/a�---Size: Diameter__%s--------------Depth�+�------------•----- Number of pits----__/_-._--.--__. g Cesspool: Distance from nearest well-------_---------Distance from foundation-------------------- Lining Ca amaterial gals. ❑ q Capacity Size: Diameter--------------------------------------Depth------------------------------------------------ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------.------ Distance . ❑ to nearest lot line-------------------------------------------- ----•-------•-------------------•-------------•-----•----•------------------------------- Remodeling and/or repairing (describe):-- y ...................... --------------- ------------------------•- -------•---------------------------•-----------------------------------------•-------------------•-----------•-----•---------•----•---•-------- 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, a les and regulatio o the San Joaquin Local Health District. --- ---..(Owner and/or Contractor) ----------- ---- (Signed)------------------------ -----1�--- . Title --- - ------ -- ------- ------ By:--------------_----•---------------- - -------- (Plot plan, showing size of lot at on of system in relation to , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------Let a''------------ ------------------------------------------------ DATE__ ---------- ----------------- REVIEWEDBY------------------------------------------------ ---------------------------------------------------------- DATE------------------------------------------------------- - BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE_------_-_.----- Alterations and/or recommendations______ _______-------____--_--_--------------._-__--_.__-•__. 1 C �----- �� ------------------------- - --------- ..-j.--- ------------------------- X6,3------, - --------- -------------------------------------------------------------------------------------------- ,,/' ? �► rte+--------•- ------------------------------------- FINAL INSPECTION BY:_-_- i/',f�-------------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CD.