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ru rrI : u5E: J2;q,4uy 3 /�---Z"-0---------- �,. ------ -- ,! -� 0--._-____.__ APPLICATION FOR SANITATION PERMIT Permit No. .... _ 9 -- -------------- --------------------- --------------- (Complete in Duplicate) / TFlis Permit Expires 1 Year From Date Issued Date Issued __� -,� �ic'S ! 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 Coun Ordinance No. 549. JOB ADDRESSLOCATION_-zy�/__- ff ---------- ------------••-----------•------------- ---------------------•------------------------------ Owner's Name_____ . _ "- F. Address ----------- Phone---------------------- -- I +� --•--- ----•• t - • -�*_--"- --------••-----------------•-----•--------•- - Contractor's Name___ :; , ----------------------------------------------------- Phone----•------ i Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: __I____ Number of bedroomsNumber of baths . Lot size _7PA-Z Or_r' Water Supply: Public system Community system ❑ Private.❑ Depth to Water Table _/aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe( --Iardpan C-1I Previous Application Made: [If yes,da.te....................} No PR--New Construction: Yes Pa—lTo ❑ FHA/VA: Yes pq' F o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi T : Distance from nearest well__- ------Distance from foundationl40EIr __f No. of com artm•ents_ p i Size- ,3 ' x y� Liquid depth_---------------- Capacity---- Disposal --- Feld: Distance from neares well'_.___._____-_.Distance from foundation__. -d-_-.___-___.Distance to nearest lot Number of iines-_S_� _--____Length of each line_--_ `""_'--_ -- - p Width of trench--- 47' •21�_" Type of filter ma.terial___�-i_----De Depth of filter material____A- ----. _.-Total length------1�r(� � ---------------J Seepage rt: _ F p ndati ___._...._.Distance to nearest loft line_"----- Numaber of to fiat it well-------Lining materaal J G :`_.Size:.Diameter_--3&. -- Depth----�J""--------- -------- Cesspool.- Distance from nearest well_________________ Distance from foundation..____-------------.Lining material____...____________._ ❑ Size: Diameter-- '-#- ----- -- ---- - --Depth---- --- ----.- - Liquid Capacity -------- -----------gals. - -- - --------- ------- Privy: _Distance from nearest well ___- ..__❑ Distance to nearest lot line------------- Distance:.from nearest building,-----. ------------- ------------"--__ ----------------------- ------ Remodeling and/or repairing fdescribe):_________-------------- -_ - --------------------•-----------------------------tqt' }, ----------------------•--- -------------------------------- ----------------------------------- b --------•----------------- ----------------------------------------------------------------------------I---------- I hereby certify that'I have prepared this pylic ion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regula s of a San aquin Local Health District, t I� (Signed) -------------------------------------- - ----- - ` -.-------(Owner and/or Contractor) BY= (Title)---------- ----------- --- - - -- - --------------------------------------------- -- - (Plot plan, showing size of lot, locationtof sys em in rela ton to wells, buildings, etc., can be placed on reverse side). } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY k -.rc - // REVIEWED BY DATE J---- –.43 ---------------- ------ DATE BUILDING PERMIT ISSUED-------------•-__---- ----------- "t - '------------------------------------ DATE--------------------------------------------------•----- - Aterations and/or recommend 'on : c�_.____-__ ------- - - - ----------% k4_-.�__'3 FINAL INSPECTION BY:..---- r -�r- � —63 ------ Date----- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,Hazelton Ave. 300 West Oak Street r 124 Sycamore Street3 205 West 9th Street Stockton,California Lodi,California Manteca,California EB 9 REVISED B•59 3M 3-'63 F.P.0 p. Tracy,California t