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I FOR OFFICE USE: : I - ��i- ------------------------------------ APPLICATION FdR{SANITATION PERMIT Permit No. --------- -------- _ .--.-•----�...... ---------�II!---------------------------------------- - -- (Complete in Duplicate) Date Issued ra40f ___---„-----""--"_________________ This Permit Expires 1 Year From Date t to Issued • Application is hereby made to the San Joaquin Local Health District for a p construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_... ------ - -_ �_ rP�-U40 ' -9� -------------------------- orName----,/ ---------- Phone------------------------------------ F wner's - il ----------- - ------------------------------------ I�ddress__ �31.05y-------------------------------------- -------•----------------•------------•------ Contractor's Name__. ,dc- `------•------ ------------------- Phone----------------------------------- i1i ��g�yInstallation will serve: Residence (+] Apartment House ❑ Commercial ❑ Trailer Court ❑ Other ❑QNumber of living units: --�____ Number of bedrooms __J___ Number of baths;-____ Lot size _1'_._.�'1_�2-_-!___4--7_________ !Water Supply: Public system ❑ Community system ❑ Private 9 Depth to Water Table _6A ft. ^� I' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam fie] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ 'll' Previous Application Made: (If yes,da`e___-----"" } No El New Construction: Yes E) No F] FHA/VA: Yes E] No ❑ .il. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer-is available within 200 feet.)-- Dista e t.)—`^ •""!�""" Septic Tank: Distance from nearest well--t6_4__-____Dist'a'��}}c fro foundation_-.�_0___-___-_".Material-________________________________-----_-______ � No. of compartments_..i _________________SizeT _ --`r:__.Liquidfdepth____ .#-___-___-.____Capacity_It _ I , Disposal Field: Distance from nearest well-470--"_---_.Distance from foundation_�b ______.._.Distance to nearest lot line_____ __________ Number of lines---.-%7------- ----"--- ength of each line------ -0--- Width of trench--.--y--��----------------_-- Type of filter materia �. epth of filter material___ --------"7-T&fal alength�a b__1________________________i, i t `�" 1 Seepage Pit: Distance to nearest we ________________ __Distance from foundation-------------------Distance to nearest lot line__________________ ❑ Number of pits----------------------Lining material Size: biometer Depth ------------ Cesspool: Distance from nearest well_________________Distance from foundation------------------- materia!_ .------------------------------- Size: ______"____-_-______________ Size: Diameter De the � �.�. ��-- -Li uid-Ca aci `. al , p f q gyp---------------------------------------------- Distance - 9 I li __-____-_-_Distance from nearest building q rivy: Distance from nearest well---=------ ---------------µ---� - ----------------- ---------------------: � I ! ❑ Distance to nearest lot line----- '.' -------------------------------------- --------------------------------------------------- ----------------- Remodeling and/or repairing (describe):----------------- ------------ ••---------------------•----------------------- -------- a f )i ----------------------- --------------------- ---•---•-•-----------------------------•---------- � --------------------------------------------------------------------------------- or- - I ------ ---------------------------------•---••-------------------------••---------------------------------------------------------- ------ . I 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, and rules and regulations of the San Joaquin Local;Health District. I � II(Signed)---- ---- - -------- -------------------------------------------------------------------- ------(Owner and/or Contractor) By:.- = --_ :_.: _...�_- •---=-----------•- _-- = _ _- _ _.{Title) _ - ----- fPlot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY '; iAPPLICATION ACCEPTED BY 4 -- ----------------------------------------------- DATE--/: -- --- -- --------------------------- REVIEWEDBY--------------------------------------------- ----------------------------------------------------------- ------ DATE-----------------------•------------------------------------ .BUILDING PERMIT ISSUED----------------------------------- ----------------------------------------------- ----------------- DATE------------------------------ ------------------------------ iAlterations and/or i recommendations:"_"_"____-__-_..-______-_L- --------•-------- --•---•------- ------------------•---------------------------•----•--- — - ------------- -- -------------------------------------- ----------- ------------------------------- 1 _ FINAL INSPECTION BY:-e -----_--------------------- Date/` i 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 E5 9 REVISED 8-59 3M 9-'63 r.P.CC, II