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FOR OFFICE USE: ------------------------ 7yJ d_ -- APPLICATION FOR SANITATION PERMIT Permit No. .... - - ------ -------- 4 (Complete in Duplicate) _ l/ -------- -- ------ - ------ This Permit Expires } 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,witli_County Ordinance No. 549. JOB ADDRESS AND L CATION_____ --- ________________________________________________________________________________________ �S-_-,1._C�_�_____�l�,.Q�Y�? '��, -------------------------------------------=- Phone-------------------------;---------- Owner's.Name------ 5•- ,6�%+��{F Address--------- . Contractor's Name------- J - ��-- ---------------------------- ----------------------------------- •--------------- Phone--_-_------------------ ------ e t Installation will serve: Residence zk_A'�artment House ❑ Commercial ❑ - Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number,of.-bed rooms --. Number of baths ._- Lot}size __?Z7 Water Supply: Public system ElCommunity system,[Erl-'rivate E] Depth to Water Table _4115�$7+- Character of soil to a depth-of-3-'feet:'Sand ❑`'-Gravel-❑—Sandy Loam-❑—Clay'Loam 4❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date_...----------------) No g? New Construction: Yes Flo ❑ FHA/VA: Yes ©A No ❑ TYPE OF INSTALLATION`ANDSPECIFICATIONS: - (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) t r Septic Tank: Distance from nearest well ___"--"-_-Distance from foundation_.-,l�__-_':_.\8t, al___ -�/� __ ,C`S ____. No. of 'compartments-_��--------------,Size l t t 11_liquid depth____.-... ______--Capacity_4111 Disposal Field: Distance from nearest well-----''-----_Distance from foundation T_/49....-_-Distance to nearest lot line__47_--_____ 00 Number of lines---------- f--------------,Length of'each line___7ia'�--_______ Width of trench._ __ ________ W {Type o_f�filter rnaferial__ j r�Ofr epth,of,filterjmaterial_,_ a-__,_-- _.Total length------ _________-__-'__-- 6 I Seepage Pit: Distance to nearest well--------- 'Distance fr m foundation----1O--------Distance to nearest lot line---t Number of pits------o2------------Lining material__/V0A!�Pe_-Size: Diameter_..,?. p Cesspool: Distance from nearest well-----------------Distance from foundation-- -----------------Lining material----------------------------------- V" ❑ _Li uid , a,Capacity Size: Diameter---------------- --------------------Dept h_.__------------------------------------ - ----- q rCP Y- ------------------------gals. Privy: Distance from nearest well--------------------------------------------------Distance .from nearest building------------------------------------------- ElDistance to nearest lot line--------- ------------------------------------- -•--------------._------------------- --- -------------------------------- - -------- Remodeling and/or repairing (describe):__- xIY� ) ------------------------------------------------------ ------ ----------- -------------------------------=•-------------------------------------------------------• -------------------------------------------------------------------- I i --------------------------•--------------------------------•-------------------------------------------4----------------- 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, a d rules and regulations of the San Joaquin Local Health District.. ---------- (Signed) i - -------- �r Contractor) -- - •----- ----- i (Plot plan, showing size of lot, location of.system ' elation to wells, buildings, etc., can, be placed.on reverse side). 3 1 FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY------�'��_-- - ---- --Gt-i�� -------------------•-------------------- DATE------ --1--�/---��- ----- - ------- - REVIEWEDBY------------------------------------------- -- --- ----------------------------------------------------- --- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED-----=•------ -------------------------------------------- --------------- -- --------------- DATE---------- --- ----- Alterations and/or recommendations:---1r_-I- -+---Ip-_01� _- ---------I ------I-1 -fillv�•---------- •C'.5�.-- �`--- ."•�- F •----•--------------- ---------------------------------•-------------•----------------------------------- -------------------------------------------------------------- -------------------------- ---•--------------------- ------------------------------------- -------------------------------------- -- - ----------------------------------_-----------------•--------- -------------------------------------------- --- ------------------------------- FINAL --------------- -----------FINAL INSPECTION BY:.------. 5------------------------------ Date. - __J----- ---`------------ ------------------------------------ SAN JOAQUIN'LOCAL'HEALTH DISTRICT. 1601 E.Hazelton Ave. 300 West OakStreet- i 24 Syc more St et 205 West 9tti Street I Blackfan,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3•'63 F.P.CC. 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