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FOR OFFICE USE: ----------- --------------- -- ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. .,1,<c`7.3. ___________4-q A. ..11 (Complete in Duplicate) p� ,This Permit Expires 1 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 application is made in compliance with County Ordinance No. S49. JOB ADDRESS AN LOCATION_)1_&-.,__e!2z `r -- - cr✓�-sK.--�iaP---- - -4.a-----°------..- Owner's Name - P - - -t' y ------ Phone-------------- --------------------- ------------------------------- Address ------ - - Address -� 4 -1 _ -------------------------------------------- -•--------•- ----•--- ••---- Contractor's Name---------- - �----- ----- --------------- -------------------•---•-- Phone------------------•-----....-----�• Installation will serve: Residence ❑ Apartment House ❑�_ Number mercial ❑ Trailer Court ❑ Motel ❑ Other ❑� Number of living units: _._1_'__ Nurnber of bedrooms __" of baths ___ __ Lot:size _____ - '5- ____________________-_.__--__.. Water..Supply: Public:system ❑. Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Said ElGravel ❑ Sandy Loam E] Clay Loam ElClay Adobe ❑ Hardpan ❑ 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:) Materia Seank: Distance from nearest wel - P ` pti l_______ 4'__________Distance from foundation__-__ILL-_ -__.. l__ _.__.__.____.____.. �[.�._�•_•r_�_ No. of compartments-------------------- depth--- --r---------------Capacity-- ] Dispo al Field: Distance from nearest well__ ..._...Distance from foundation��_1�_-_____.Distance to nearest lot lineS'_- _.- -..__. Number of lines,._._;___E_---___.- Length of each line_________l.__4_0 __;_._.Width of trench-.__Zir------------------- ,.Type of filter material____- _____Depth,of_filter matteriaL__-/- -------------Total length--------t_d6i_______________---_____- Seepa Pit: Distance to nearest welL.____L9 ._h____:Distance from #oundation____l40_._____.DIs ante to nearest lot.line_________________ EK Number of pits..._-_.�___---Lining.material____ +:"Siie:.Dia mete r__ ._.__. ----Depth____ -S r " I Cesspool: Distance from nearest well______________ Distance from foundation_____________-1_,_._ Lining material------ '.____._________________- ❑ Size: Diameter-------------------------------- -- Depth-------------------, ------------- - -------------Liquid Capacity-----------i---------------gals. Privy-.' Distance from nearest well________ _______________________________'Distance from nearest building_______________ Distance to clearest lot Gne _ .' . .—=-------------------••---------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------- ;. ____________f i ate} i _ � �-- #. i r ` ` k ----------------------- ----------------------------- ----------------------------------= --------------------------------•----------------------------------------•--------------------------------------- ` ----------•----------- --------- ----------------•---------------------------------- -- I It hereby certify that I 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. a - t l (Signed)--------------------- - ----------------------------------- ---- - * and/or Contractor) -- - - - - fes- y=-------- -- ---- == (Plot plan, showing size of lot, location of system in relation to wells,_buildings, etc., can be,placed on reverse side). h 1 A FOR DEPARTMENT USE ONLY I r i APPLICATION ACCEPTED BY---- - -- ------ ------------------------------ -------------------------- DATE-- j REVIEWEDBY.----------- --------------------------- ---------------------------------------------------------- DATE--, z -------------------- --- BUILDING PERMIT ISSUED----------------------------------------------------- ----------------------- - = DATE # t ----------------------- Alterations and/or recommendations-------- ------------------- -I-----------------------------•------------------------------- -•------------------------------------ ------ -------------------------•------------------------------------------------------------- ----------------- ----------------------------------=---•-------------------•----------------------- --------------- F # _..__.___.#___________________________________________________________________________________`__ _ --______.______--_-__________._____.__._-----_--____-- _---._--__..____-___.____._.._______---------------------------___.-._-__.-_____..-.. _.___..__C_____________________________ _____ , t l FINAL INSPECTION BY: ._ _ __ ...----- --- Date---------&, ----------`---------------------------- SAN ----SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 31A 3-'63 F.P.CD. )