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FOR OFFICE USE: ------------------- -- <. � (,1-/---------------- 4 J_�-_-_-. APPLICATION FOR SANITATION PERMIT Permit No. _..I.-A.-&o ______ _________"_o (Complete in Duplicate) l/,q This Permit Expires 1 Year From Date Issued Date Issued .__._ _.=__7_;l.ly. 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. ,/;,5hl,4FY [�/, / �T /0-9� JOB ADDRESS AND LOCATION--- 23,X__!_4---- ------- `T` 4�s------------- Owner's Name-------------------------- --------- Phone.o•e 7_`�,W --- --- --- ------------------------------------------------------------------------------------------ Address-------------------- =' 1�5---------------------------------------------------------------------------------------------------------•------------------------------------ Contractor's Name.............. ----• -=-----------------=---- ••--•---•------ Phone-,/i'.,;.�n_6 97. Installationwill serve: Residence 1� Apartment House F1 Commercial C] Trailer Court E] Motel ❑ Other [INumber of living units: .-/---- `Number of bedrooms _!__.- Number of baths ----/-- Lot size ----------l�TGG�f� ---------------------- Water Supply: Public system ❑ Community system ❑ Private x Depth to Water Table .60 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑. Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,Q Hardpan ❑ Previous Application Made: (If yes,date-.---._.__.--------) No (a New Construction: Yes [ff No D4 FHA/VA: Yes ❑ NoX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public seweris available within 200 feet.). Septic Tank: Distance from nearest well __,1:0_.__•Distance from ffoundation__._2-0-- .-.Material__, ________. [ No. of compartments--_____�____-___.-.Size.3__?X__,S____15.1E'�__Liquid depth__..._7_ _'7----------Capacity._slelo ____.__ Disposal Field: Distance from nearest well-----G V__`._.Distance from foundation-__-2:p_`._...Distance to nearest lot line----loa.!. Number of lines--------------- Length of each line----------AYQ_-----------Width of trench--___--_.��_________________ Type of filter material---- _f?/___Depth of filter material---------- f'"_Total length-----------------_______ _'__-_-_ ',v Seepage Pit: Distance to nearest well---/A. tel!____Distance from foundation__.._ ®.'__-.Distance to nearest lot line--- [ Number of plts___.__�_____..____Lining material______.__ _Size: Diameter____-_ ��_._-__-Depth_______? ,3`______________ / Cesspool: Distance from nearest well------- ---------Distance from foundation--------------------Lining material-------------------------- -- _-____.. A ❑ Size: Diameter----•- -•-----------------------------Depth-------- -----------------------------------------Liquid Capacity---------------------- •---gal Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-___-__-___--_____-_-•--.-_._---------- ❑ Distance to nearest lot line---------------`------------------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe) � 1�i`' .........Q/ ------` f'�ST ��---------------•-------------_---•.-----------••- ••----------------------------------------------------------------------------------------------------------------------------------------------•••----------------------------------------•--------------------------- --------------------------••-----------------------------------•-•------------•----••------------•-•--------------•--------------•------•------••--••-----•----•-------•-----------------------•---------------------------- ------------------------------------ -------------- -•-----------------------------------------------------------------•------------------------•-------------.-------------.--.--------------------------------------- I hereby certify that 1 have prepared this application and that the work:will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------------------- --------'� -------------------------- ---------------------------------------(O ner and/or Contractor) By= •-•--•. --•- �- (r+le)------ -------- ---- -- (Plot plan, showing size of lot, location of sys em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �` DATE.._._ _ _-� - APPLICATION ACCEPTED BY 'L/� - ---- ------------------- �f REVIEWEDBY------------------------------------------------------------------------------------------------------------------- ------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------- - DATE -------_------------------------------------------- Alterations ----- ------------ --Alterations and/or recommendations:--.N�._.°-_.y__-- '_9......... _;4`.._., ` ",H-� -=-moi u`-�-n ...-------Itz--Kms.=--� ---- ------------------------------------ ----------------------------------•--------------- ----------------------------------------- ----------------- -------------------------------------------------------------------- --------------------------- ------------------------------------------- ---------------------•------•------------------.----------------• ---------------------------------------------------------------------- --\—. ?`�`�f FINAL INSPECTION BY:.------�%-;-----.----� � ----------- Date------------- --- ' ------------------- - - ------------------------------------------------------- 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 5-59 3M 3•'63 F.P.DD.