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FOR OFFFCE USE: __+_____________________ ---------------- APPLICATION FOR SANITATION PERMIT /Date mit No./`1..�_ -------------------- (Complete in Duplicate) .p . Issued'..5;1 -------------------•-- -- -------_-�rrt__.___._------.-.- This Permit Expires 1 Year From Date Issued � l 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 JOB ADDRE40 If SS AND LOCATION_ 7�t�__ -k'Ile - - �r . lc R 9- 4, Owner's Name------ '4- -------------------------------------- -- --.. Phone = ...�0 .Address---------- --- • ---- - -� -- � ------------------ - ----- -- --- - ---- ------------------------------- �` Contractor's 'Name----- Phone----------------------------------- �Installafion will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �r Number of living units: ________ Number of bedrooms ________,Number of baths _: _ Lot size ___e �etrri.� .hZ..____________________ 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.__.___.._..______I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑Y TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.)- - , i Septic Tank: Q Distance from nearest well-----------------Distance from foundation--------------------Material________________________________________________. ❑ == No. of compartments------------- ---- ----Size------------------------•-------Liquid depth---- --------------------Capacity----------------------- At ,Dispos Field: Distance from nearest well-_1A....._Distance from foundation----/t�__ ___.__.Distance to nearest lot line----------------- 10s _✓_-_-____ �:. f Number of lines___.____"____... �_y_�_ Length of each line____ _ ____________Width of french----- _f__-_.._.____.________.__ Type of filter material____� 4-_{______Depth of filter material_.___ _ __ _ ......... � ,> otal length------r�rL�--------------------------- �..Seepage Pit:( Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____.:___----__- ❑ '7 ( Number of pits-------------------- Lining material----_---_--------_---Size: Diameter.------------------.---Depth--. ----------------------------- " Cesspool: nf, : Distance from .nearest well_________________Distance from foundation-------------------- material-----.__________._____________..__. Size: Diameter----------------------- Depth--------------- Liquid Capacity _____gals. P}•iyy: '" Distance from nearest well------ _Distance from nearest building------------------------------------------ t.,❑ .� Distance to nearest lot line'= Remodeling and/or repairing (describe):__.._______. -__-I 1 ) ------- --- --;- ------- ------------------ --•-•------ _ .M: 3 �, t t . -F ` -� - ------- ----------- ------------------------------------- w� -. : k I he'reb certif that 1 have prepared this a lication and that the work will be done in accordance with San Joaquin County Y Y P P PP 1`ordmance-s, State laws, and,-rules and regulations of-the San Joaquin Local Health District. { . •------------------ ------ or Contractor) act----------- t _ _- - - ---------- - ------ BY:------------- rtle}----- - lPlot plan, showing size of lot, location of system in rela#ionr#S welts, buildings, etc., can be placed`-on reverse side)..,�•�-�=4- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ __ _ --- -------------._____----------------------------------- DATE---- --�'--1--�� ------•-"-------------- ------ REVIEWED By------------------------ ----------- --- ------------- ------- DATE----- - ------------ BUILDING PERMIT ISSUED---------------•----------------------------------------- ---------------- ----------------------- DATE------------ Alterations and/or recommendations---------------------------- ----------------------------------------------------------------•-•-----------------------"---------- -----------"---•---------------------"-•-------•-------------------------------------------------•----- ----------------- •-=---------------------- --------------------------------- -------- ------ ------ - ----- . ------------------------------- ------------------------------------------------- ------------- /FINAL INSPECTION BY:-- _-- --�-�-�-------- � -- - ------------- --- ate_ ' 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 1 ES 9 REVISED 8-59 3M 3-'53 F.p,CD. �a.R �"�-n;tth.,.-.��'a:P,•#s. -rr..,. ,� - �_a�r ��.:r :;ya