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F OFFICE USE: a 6/ C 3 ------- ---------- 3� - 3 2 S APPLICATION FOR SANITATION PERMIT Permit No. ........................ ----------------------- ---------------- (Complete in Duplicate) Date Issued ..1. . - 3 -------------------------------------------------------- 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 herein described. This application is made in compliance with County Ordinance o. 549 JOB ADDRESS AND—LOCATION---- �� " '--------------------------------------------------------------------------------------- Owner's Name------ -�� . ----- Phone.................................... Address '! .... Z - . - - ----------------------------------------------------------------------------------------------- Contractor's Name----------/0 -lam --- ----------------------- ----------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -��mmunity / mber of bedrooms -_._w�__ Number of baths ---/. Lot size . 0'4e_t2,' ..................._-.-._-...- Water Supply: Public system system ❑ Private Depth to Water Table 6— Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa y Loam ❑ Clay Loam ❑ Clay ❑ AdobeET-l"Hardp ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes [�IVo❑ FHA/VA: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well_.,__!" Distances from foundation.u/--- .._ __Mate,i I-��o�-... No. of compartments.._._-7i_._-._._Size...u � _---Ca acit U -` q F! -- - P Y-- -------•----------- Disposal geld: Distance from nearest well.-..Distance from foundation-0../......Distance to nearest lot line-,.1�f.-_--- Number of lines..... .........-.....-----._...._-Length of each line......y?�_, i- Width of trench. . .-%.._..__..__.._.._ Type of filter materiaI__.�.2_e?P�e.-Depth of filter material__/_(.!_.___._Total length.._....%4?—f------------------------ —I !/ /d ' g—� Seepag it: Distance to nearest well......................Distance from f`ou�dation_..................Distance to nearest lot lino._.__._.._.__..._ Z Number of pits--.--/-------------Lining material---,YAC//"-------Size: Diameter.. Depth.-�. Cesspool: Distance from nearest well.................Distance from foundation--------------------Lining material_.-...._--_-__-__.._--.-..._..-.----. ❑ Size: Diameter-------------------------------------Depth--------------------- -----------------------------Liquid Capacity-----------------------_--gals. pi Privy: Distance from nearest well.................................................Distance from nearest building.--.__.._-_--._-._...--.•-•--._..--._--... 6, ❑ Distance to nearest lot line--------- ---------------------------------------------------:......... ------- - t0 Remodeling and/or repairing (describe) ------ ---- --------------- �: -------------------------------------•----•---•--------------•------------•------------------------•-•-----•----------•-----------------•----------------------•--------------••---------------------------------------------- ------------------------------------------•---•---------•--•-------------•--------•-------------------------------------------------------------•--•---------•------•---------------------------------.•---------------------- I hereby cer ' that I h e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat s, a r n -regulations of the San Joaquin Local Health District. (Signed)--- ...... ----- ---- --------------------------------------------------------------------------- (Owner and/or Contractor) B .................. • ---------- - ----- -- --• - - - - - (Title)----- 1 Q (Plot plan, showi a of lot, location of system in`refation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ''`GO-------------------------------------------------------------- DATE------ ------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—------------------------------------.- DATE------------------------------------------------------------- Alterations and/or recommendations:.._.__. ------------------_____ -----------------••-------•_ ----------------------------------------- - ------------------------------ -- - -------------------------! v ' = - �"' -�' " G � `` ° --------------------------------e`--�''------...-------........... FINAL INSPECTION BY:------.... ----------------- .......... Date-------1 ...�------------------------------------- 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-S9 31A 3-'63 F.P.CD.