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FOR OFFICE USE: -------------------=--- --------------- ------ --------- it No. 7 APPLICATION'IFORrSANITATION PERMIT Perm ............. ---------------- --- ---- ---------------------- (Complete in Duplicate) 7// Date Issued ----------------- --------------- . This Permit Ex iris 1 Year From Date Issued Application is hereby made to the San Joaquin quin 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 ADDRESS AND LOCATION_'_ ._ ------------- -------------- - I-----------— "7 Owner's Name-'-- TLC----- - ---------------------------- Phone------------------------------------ ------------------------------- Address------I/-_3!9----- ---d-d ---------------- --- ---- -- ------------------------------------------------------------------------------------------- Contractor's Name--• ------ - - --------- -------- ----------- ---------------- --------------- Phone----------------------------------- I Installation will serve: ?Residence Apartment House E] Commercial L] Trailer Cour.OEI Motel Ej Other E] 4 1J# Number of living units: ___I__ Number of bedrooms_,.__ Number of baths - ------ Lot size -------------------------------- E!KWater Supply: Public:systemO .,.Community system P rivate F1 Depth to Water Table ft. Character of soil to a depth of 3 feet: I Sand Ej Gravel E] ' Sandy LoaMrE] Clay Loam Clay ❑ Adobe [3 Hardpan Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes El No [:] FHA/VA: Yes F] N6.E] TYPE-OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic;an k: Distance from nearest welL_j'J_'.1*__Distance from foundation_______ 4Z------Material------4tel-�-wa-------------------------11 1- No, of compartments----7---—------------- Liquid dep.th---- ---------Capacity... Dis I Field: Distance from nearest well.-,.5- -1-I.-Distance from founclaTion----IA-0 ..___.Distance to nearest lot line_'____________V 7? 'Number of lines-------------#�_v-- --------Length of each line__________--------------Width of trench-------X------------------------ Ier�------Total length--- a_=__________.-.__ ___._ of filter material------ ____k---------Depth of filter ma+er!aI_.___/4__ Seepage Pit. Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line------------------- E-1 Number of pits----------------------Lining material------------ -----Size: Diametei---------- ---- ---- ---Depth-----.---------------- ------- Cesspool.- -Distance from nearest weJl-----------------Distance.from foundation-------------------Lining material-------------------------------------- -,t�4 r._ ga —�-Sizo:-Diameter--- -?Depth.,';--------- ------------------------ -------------Liquid Capacity--------------------------- - Is Privy: Distance from nearest well_____________________ --__._.-Distance from nearest building------------------------------)------ El Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------- Remodeling ar�d/or—r6_P repairing {describe) ------ . . -------------------------------------------------------- ------------------------------------------------------I---------------I------- ---------------------------I-----------I----------------------- ---------- I' ---------------------------------------I------- --------- ------------------------- --------------------- --------------- -------------- I ----------------------------------------------------------------------------------------------------------------------:--------------- ------------- -------7------------------------- ------------- ---------___--------------------------------------------------------------------------------------------------------------------- ------------ I hereby certify that-(-have-prepared-fhis application and that the work will be done in accordance with San Joaquin County ordinances, Sfaf6-laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----- - ---- -- -- - - --- 7 sand/or Contracfor) �-------- By:------ --- -i------------ -L.L.-' -a-------------------------------------------------(Title)-------------- -----------------------------!---------------- (Plot;'plan, showing size of'lo+, I afion 'o rn Sys ein re Cimn to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY ------------------------------------------------------ ------1----------- ------------ APPLICATION ACCEPTED BY-1-- DATE- REVIEWED hY--------i I ----------------------------------------------- ----------- ------------------- ------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------�__t-----------------------------------I------------------------------------- ----------------- DATE-------------------- t--------- -------------- Altera+ions and/or recommendations_________________________..__: ___.---------1-1-------------------------I-------------------------------------------------------------------------------------- --------------------I-------------- -----------------------!------- --------------- ------------------------------------------------------------------------------------------------------- ---------------------------- ------------------ -------------------------------- i. ---------------------------------- ---------- ------- -------------------------- ------------------------------------ t. ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ ----------------------------------------------------------------------------- ------ - ---------------------------------------------------- -------- --------- ---------- ----------------------------- FINAL INSPECTION ......... --- Date------- f-- -- r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.PX0.