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FOR OFFICE USE: -— __ __� D- :. �laX---------- APPLICATION FOR SANITATION PERMIT Permit0. lf (Complete in Duplicate) ; Date Issued _�y ._ - -------- --- This Permit Ex ires 1 Year From Date Issued � 3 y 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. 4 LOCATION JOB ADDRESS AND LOCATION.______s _ ---___fV -_----- ---------•---------------------- /-------------------•-------------------------- ... Owner's Name .�c.��9/Y_ r-' �'� 1f /�� Phone/•��f Address----------------C- , Contractor's Name----- �/Y[' Phone.__J _6_g6o Installation will serve: Residence Rr Apartment House E] Commercial E] Trailer Court [) Motel ❑ Other ❑ Number,of living units: --/-- Number of bedrooms _ _ Number of baths ---I.- Lot size ----------- ---------------- Wafer y,5_=0-'•-.•-_-_-_-_ Wafer Supply: Public system Community system ❑ Private ❑ Depth to Water Table h-4? ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [B"'Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,d:ate____________________j No Qs New Construction: Yes ❑ �No ®' PHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS; r I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . n Septic Tank: Distance from nearest well_____________ODi take from foundation-------------------.Material----------_---------------------------- ❑ No, of compartments_.___.____.____---- Size___-#_________________________Liquid depth---------- --- - Disposal Field: Distance from nearest well _.-___._____:. Distance from foundation_____________I!�_ Disfance to nearest lot line----------- E❑ Number of lines-----------------------------------Length of each line.----------------------- -.Width of trench-------------------- �. Type of finer material--__._____-____--------Depth of filter material_________________'-_Total- length--------------------------___---------•- Seepage Pit: Distance to nearest. _ well-JyQ1V,-Distance from. foundation____l_Q_.__:,__.bistance to nearest lot iine_._1Q'.- Q Number of pi#s___ __ ___________Lining material ,---F size: Diameter----- `�' "Depth----------- -------------- cesspool: -`----_--•Cesspool: Distance from nearest well____________1.Distance-.from foundation_______________*--Lining material__._______.__- ET Size: Diameter--- 5 ---------•--- .Depth...... -- --------------------- Liquid Capacity gals. Privy: Distance from nearest well----------_------________-----_- - . ! " ._.:_ _._..-Distance from nearest building_._---_________________ - ❑ Distance to nearest lot linee-i--- ------- ------------------ x ------------------------------------------------------------ r t Remodeling and/or repairing (describe):--------"./ d -------- C---------- X/Sl/1 ----._` f'`-£ EfJ--------------------------------------- # --- i t ��Y _. --------- ---------------------------- = t ._ ` { _ _ .: I hereby certify that I have prepared this application and +ha+ 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. (Signed)----------- s5/ '--`SQn/.� -1.'vc----------------- ------ F [ wner and/or Contractor BY- C. _ Wiz'Q_ - Title (Plot plan, showing size of lot, location of system in relation to wells, buildings,'efc., can be placed on reverse side). -`FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY =f" ..------ _DATE ,. . l Z�, ---------- -- REVIEWED BY ---------------- ---.: ;DATE --------------- BUILDING PERMIT ISSUED------ ---------- 1 - T ------------------------------- DATE----- - - Alterations and/or recommendations:_____, „w -C:- +" " 2�� 9 P / p �� = � 7� � -_- -------:-- ----- ----- -------------•- ------ ----------------------- t r' - = . -V c _- --------- -------- �--- • ----------------- -._.-----------�-^------------ fit"--c ----- = '�- ' 'r e i � --- ------------ � `�`-- -------------- - - - L - -- .. ----- - ------- --•-•- ----- /rte -..._ _ -___ -� .-,r FINAL INSPECTION BY------------- --------- ------------------- ------- ------------ Date �� [y .�S�'14 � t '� ;ti r+Mt SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 6.Hazelton Ave. 300 West Oak Street T24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S 59 3M 3-'63