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FO OFFICE USE: r �! --- - APPLICATION FOR SANITATION PERMIT Permit No.7!�� .�7.. -------- ----------------- ----------_---v---- (Complete in Duplicate) Date Issued --------------------- -------------_---------------------------------------- I 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 No. 549. JOB ADDRESS AND LOCATION ,a L�' g: ' - C ._, P_��tI----------------- ............. Owner's Name..------ 7.--�....---- -------- --------------------------------------------------t-------------- Phone..VV Addressf.�.f f_....-•--e-,----- ' =TIj a. '-----------•----------•--------------------------------------- Contractor's Name............oc<- -4-7---- f"t- - c=sE --•----� - : x k-a Phone._.,.I.e.._. .�:Ca' Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _`.Z- Number of bedrooms -_`-- Number of baths _Z-_. Lot size •____________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .494�t. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a Hardpan ❑ Previous Application Made: (If yes,date___----------___....) No;ff New Construction: Yes ❑ No JR FHA/VA: Yes ❑ NO,I1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if`0bblic sewer is available within 200 feet.) Septic Tank. Distance from nearest well_________________Distance from foundation-----_--------------Material-----------------------.__________:_._:_______-_. K �i` No. of compartments--------- -----------Size----------------------------_---Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well 1 :__Distance from foundation....,/.0..........Distance to nearest lot line-_.ZO_'.___. f�j t4 Number of lines----------/__------------______ __Length of each line--------2-,c-_!-----------Width of trench.____-_------__-•--_-____-__ l) Gcdt? Type of filter materia .. _ s_Depth of filter material___./_CO__......Total length............................. Seepage Pit: Distance to nearest well' j4'-'a`1f______Distance from foindation...._ Distance to nearest lot line_-°'......... $ Number of pits______/-_____________Lining material S•__�+E _.Size: Diameter____.__f Dept h_____....' 3'_'.______.___ W Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-___________-_--________________---.-. ❑ Size: Diameter--------------------------------------Depth---------- -•------•--------- ---------------------.Liquid Capacity----------------------------gals. 1/) Privy: Distance from nearest well----------------------------------------:--------Distance from nearest building------------•__.-___________-__-_______-_. ❑ Distance to nearest lot line-------------------------------------------------•------------------•---------------------------------------------------•----•---------------- Remodeling and/or repairing (describe):_______- ___dl- --_✓ s'___._ ----------------------- p, ---------•------------------------•-----------------•---------------------------'=---•----- ---------------------------------•-----------•------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------- A -------------------------------------------------- ----•----•------------------------------------------------------------------•-----------------------------•--------------------------------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. (Si ned ---••-------- SY-- '% -- = ."`'� ==_ g )•._________.___--__,___-_ ------__3._�-�_ -- _(Owner and/or Contractor) BY: t' �`'�'' =r. `co.'t '°� ----- - (Title) (Plot plan, showing size of lot, location o `system'in relation to well`s;buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- _ '` ------------------------------------------ - -•---- DATE------ /' '7Z--------------------------- REVIEWEDBY------------------------------- -------------------------------- --- ------ DATE--------------------------------------------- ------ BUILDINGPERMIT ISSUED-------------- -------------------------------------- ----- ------------------ DATE------------------------------------------------------------- Alterationsand/or recomme datio s--------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------,1---�/T-. y-------� - � ' ------------------------------------------------------------------------------------------------------------------------------------------ ---------------- ----------------------------------------------------------------- ------------------------- �-------,----------------------------------------------------------;----------------------..------------------------------------------------------------------------- FINAL INSPECTION BY:--------``_1-<-6e------------------------------------- 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.P.CD.