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FOR OFFJCE USE:, ' ------------------- ------------------------- ------- _ ------------------ ----- --------- APPLICATION FOR SANITATION PERMIT Permit No. •-� �0 ' - ------------ �]-, .� ---------------------- (Complete in Duplicate) (/ Date Issued _____ --------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and 'install the.work herd desc i d. This application is made in compliance with County Ordinance No. 549. f{-Pw 25-3_ 300_ JOB ADDRESS AND LOCATION B_1.4j? R _ C�INEI 13-f- � 0(pare { Owner's Name----------1tt 1------- ---------------------------------------------------------------------- _ C•4 �4_ -- ---�-------�-- Phone" '---- -- `�,_l-------- Address------------ `- '�- .._.__ 4_}�_:_.�°• -•-•-----•• -----=-----------------------------------------••---•--------•------------•-•----------- :. Contractor's Name----- = r ):S ---- I---S Q 1 15------------ ----------------------------------- Phone-11a.4.5...6 0-7---- Installation will serve: Residence �( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _ Number of living units: A---- Number of bedrooms _-�-- Number of baths -- _ Lot size -----------------(2�-_Aa1 ------__-_------._ Water Supply: Public I 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,dote---------:..........) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No 19 .-9 TYPE OF INSTALLATION AND SPECIFICATIONS: y (No septic tank or cesspool permit+ed if public sewer is available within 400 feet.) pp Septic Tank: Distance from nearest well_jW........Distance from foundation---)_Q!_._-_---Materi i-_-eP _e _ _ �_-- ------------ K_ uid de th______ � CaacitNo. of compartments,__--- Size__` ._____T_ N- Disposal Field: Distance from nearest well_.5V.0__'_Distance from foundation_____/._4�_'----Distance to nearest lot line----- _.----_ Number of lines----------'L'�--------.--------Length of each :. .. .....Width offrench.___...._..'�._5l_"__._.____ Type.of filter material.___' i��t-.:Depth of filter material-------/9........Total length--------------'- ._--..._..____-- Seepage Pit: Distance to nearest well----- ----------------Distance from foundation--------------------Distance to nearest lot line----------------- F1 Number of pits----------------------Lining 'Material-----------------------Size: Diameter------------------------Depth--.--------------------.--.------ Cesspool: Distance from,nea-rest well-----------------Distance from foundation--------------------Lining material_---__._._______-________-_-.--. ❑ Size_.,Diameter.�---- ------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. �. Distane-frorri nearest weft* .':'"":`."' _~_._..Distance from nearest building_________ _ .e_ ------- ------------- --------- Distanceou to nearest lot line._- ._---_--t'"=""=r " _ "�'�"�"'+ b , Re odeiing and repairing (describe):_______.r_ x ---------- _ �_-___-----__ -----.__-�.P��t`-'----------------- �— i t - '=-----= ------- -- v _ - r a �t r - . _ _ ^tel .._ - > __ __ _ _ _-_ _ __ _ ' ------------------------------------------------- _ I hereby certify that I have prepared this application and that the work will be doneTin-accordance with San Joaquin County i ordinances. State laws, and rules and regulations of the San Joaquin Local Health Districta Si ned -I €. - 12- ✓ --------4---- --- _.-.-_._____ Owner and/or Contractor ( 9 ) -12-01— Vis : . ---- _ ( / ) } BY� 12.01 -------- -ti•.rC..--------------------------------------------------------{Title)-----------�� {Plot plan, showing siie.of lot, location o system in relation;to_,wells, buildings, etc., can.0e placed on reverse side). �.:.. { - € FOR DEPARTMENT USE ONLY r* F F APPLICAT.IQN ,ACCEPTED BY-------------:-------------------__--------------------------------------------------------------- DATE-"-------------------------------------- ---------------- ' REVIEWED"BY---------= --------=------ ----- ---------- DATE-Li ---------- BUILDINGPERMIT ISSUED--------------- -----------=------------------------- -------------------------------------- DATE'--- ---------- --------------------------------------- Alterations and/or_recommendations:fi---------------------------------------------------------------------------------------------- ------------------------=•------------ ------------------- ------------- --------------------------------------------- I = --------------------- ------------------------------------------------------------ --------------------- ''------------------------------ - 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 8-59 3M 3-'63 F.F.CO. - - v