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FO FF CE U�E: > y? ------------------------------ --------------- _ -------------- APPLICATION"'FOR SANITATION PERMIT Permit No. ... �.G.•Z ..- ---------------------- --- (Complete in Duplicate) i -- --- --- ---- -- -- Date Issued This Permit Expires 1 Year From 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 CATION------- ,1 L.-- r �� .!4 . ------------------------------------------------------------------ Owner's Name------ pPhone.................................... Address ` �`Z Lc> n /— f y -� = Contractor's Name--.--- •- Phone. Installation will serve: Residence ©Apartment House ❑ mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1---- Number of bedrooms .lan-? Number of baths ---,-_- Lot size : ,1 v................................ Water Supply: Public system 0-60mmunity system ❑ Private ❑ Depth to Water Table 46A* ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand m ❑ Clay Loam ❑ Cla Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Ye o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan Distance from nearest well_______ _______Distance from fou dation-d/-----.M �riaL _ �G ------------ No. of compartments._. .____._.__Size. .. �J.....Liquid depth_.. ,/ —---------Capacity...l-_air'----- Disposal Fie Distance from nearest well_7777�ance from founclation./.�-O___/......Distance to neares to line._..... Number of lines_.____/-----.-71-------------Length of each line_.-__520Z•-`--------Width of trench_ �----------------- � Type of filter material..._�/ 1^64_ epth of filter materialJl ------Total length_..fila!________________________ Seepage Distance to nearest well____ stance f m foundation_w_�_____.Distance to nearest lot line._ Number of pits---------- -----------Lining material_.... .oc_ __-Size: Diameter-_"? Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- F1 _-_--_ _-.______-_-_-_.-----------_.❑ Size: Diameter_-----------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well____-_--_-----.-------------------------------Distance from nearest building--------------._._..._-----__-____--__-_ ..� ❑ Distance to nearest lot line 1 line-------------------------------------------------------•------•----•---•---•----------•----------•------------------ -------------------- *lin /orepairing (describe):-----Rem � i1 -!.n rAS� ---------------- ----------------------------------------------------------••-•--•••---------------------------•----------------------------------------------------------•---------------•---------------•-------------------------- I hereby certify that I have pre ed this application and that the work will be done in accordance with San Joaquin County ordinances, State I and rules n r ulations of the San Joaquin Local Health District. (Signed)--------------- --- ------ --------- - -- -- ----- --------------------------------------------------------- ------------------------------------(Owner and/or Contractor) By:........................ -• • •--- - -- - ------------- - --------------- - Title- -• -- --'"---------- ----- (Plot plan, showing siz o 6t, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- J------------------------------------------------------- DATE---------` / --- ------------- REVIEWEDBY------------------------------------------------- ---------------- ------ DATE- -.---------------•--------------------------------------- BUILDING`PERMIT ISSUED................... ------------------------_.................... -----------------•DATE----------------------------------------------- Alterations alld/or reommendations: L"'( �'�/ { t7F / _ '-"�''L '--.fir -------•--•------------------------•-------------------------•---------------•--•--------........................ -----------------.-----------• --•--•---------- ----------.-----------------------------------------------•----------------------------------------------------•------------------••-------------------------------------•-- -----•---------------------------•---------------------•- ----- --•----------------------•--------------------------------------•--•-----------••--------------- ------------------------------- ------------- --------------------------------------------------•--.----------•--------- -------.................. ------------------------------------------------------------ --------------------------------------------- /! 4 FINAL INSPECTION BY:.---- Date.....-jK.--'7r-- I��----------------------------------------------- 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-S9 3M 3-'63 F.P.CC.