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FOR OFFICE USE: ----------------- Permit No. �-- ------ -------------------------------- 1i13 fl----- ----- ---- APPLICATION FOR SANITATION PERMIT _ .(Complete. Date Issuedin Duplicate} / ------- ----------- ---------- - � ----- -_-...•------ 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. .yyr-� 4" S. ------- . ' JOB ADDRESS AND LOCATION=_`_ ✓.3 :__ '' ` - Owner's Name-------- ---------------------------------------- e -------- Phone - 11] ____________________________ Address - --- _•• ----------- I r , �s ; { ------- Address--- T .----------- Phone----_------------------- --------- Contractor's Name`..- - ---__ -••------------------------------------ Installation will serve: Residence [?"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑} Other ❑ 1 - {.Number of living units: ____;Number''"of bedrooms _ -.Number of bathsA. _____ Lot size ___l_, ---•------------- i' T / � ft. l Water Supply: Pulolic system Community system ❑ Private❑ Depth`to.Water Table Character of soil to a depth of 3 feet: Sand [] —Gravel ❑ �S ndy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[ ardpan ❑ Previous Application Made: (If yes,}date__-----------------1 No � New Construc+ion: Yes El No [t- FHA/VA: Yes ❑ No ®-- - X TYPE OF INSTALLATION-,AND SPECIFICATIONS: (No"septic tank'or cesspool permitted if public sewer is available within 200e,feet.) Al. �, i 6'f j ,r4 Se�ti�Tankf Distance from nearest well---------- ---------------- ----------- ________ Distance from foundation------------------..Ma#erial____' _____--_.____________-_____________-. �# t , u517,q y No. of compartments------ ----------" - Size.. --Liquid depth--------- ------ ---- Capacity------ ; � . �j n♦ �G°� s II Disposal Fie,,ld: �... .-,-Distance from>nearest well--_ foundation___. _ Distance to nearest lot line ___________ Number of lines___:_-.--rte-^._ ` g. . of each line__ _ �_ � Width:of trench . r-----------------••- �%/Irj 6 +� en the ' i T e.of filter material. _J/ _- nep 1 __ Totaf len th__ ..� f '+� th.of filter material--- e� r g t f i, Yp arr �:. Seepage Pit: Distance to nearest well___'-____.__f Distance from fo/�undation--__-V---____Distance to nearest lot line__.________.._._ ,p Number of pits---!f_-----------Lining material,�_� /.u__ Size: Diameter :_. -} p� V' De th ___ ------------------------------------ Cesssp ol: Distance from nearest well__—__-:_-,.r--Defiance from foundation_-----------------Lining mAeri i.ty_.-.______________.______g M ❑ gals. a Size: Diameter- - ------ ------- P ._ V -- '-- ---------• -- from Privy: Distance from nearest well.. ng--------------------------------------- ❑ Distance to nearest --------- lot line------ ---------- -- ----------- --------------------------------------------------------------' ------ /} f Remodeling and/or repairing (describe):_-- ;%�` '' ' -------------------_'_=. --------;;-- I ii ------------------------------------------------------------- 11 •-------------------- i1 --------------- ---------=-------------------------------------•--------- •------------••------------•----•---------------- 1 hereby certify that'I have prepared this application and that the work will .be done in accordance with San Joaquin County ordinances. State lawUandlesand regulations of the San Joaquin local Health District. li -- 6�vruos.atsdf�r Contractor) (Signed)-------- --- 1� = -•----(Title) By:--------------------•------------------------------------------- -- - (Plo+ plan, showing size of lot, location of sys+e i relation,to_wells,.buildings, etc., can be placed on reverse side}. 1. ;.� FOR DEPARTMENT USE ONLY i f ------ DATE--------�--Lz�1:_. --------------�' APPLICATION ACCEPTED BY--------�=- - -=--- -�,�C� ----------- ------------------------•-- -- DATE---------•-•-----------------=---------- - REVIEWED BY----------------------------------------- ------- -------------- ------- - ----------'---- -------------------------- DATE-•---------------------------------------=-----------•--- BUILDING PERMIT ISSUED--------------F--------- - ----------------------- Is i Alterations and/or recomm d ionj: - - --------------------•----------------------------------------------- "�``— �i------------- ----------------------------------------------•--------------- ---------------------------------------------- -44-0 -�_ -y ---------- tt ------- ----------------- 1 ------------------------------ ------------------- --------------- = - - ------------ -------------------- FINALh INSPECTION BY:.------ �` '--------- --------------------- 1 4 Date_.. -- -- �S SAN JOAQUIN LOCAL HEALTH-DISTRICT I 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street a 's Stockton,California Lodi,California Manteca,California Tracy,California p ES 9 REVISED B-59 3M 3-'63 F.P.cu, I r I