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FOR OFFICE USE: --- --------------, Y �'__ -.,o. _ ----------------------- ------ APPLICATION FOR SANITATION PERMIT Permit No. ,x_7__3. --------------• --- ----- ----------------------------- (Complete in Duplicate) �li 6ql I __ ... This Permit Expires 3 Year From Date Issued 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-------- •--- --•- - - s-d- ----------------- Owner's Name � - _ ----------------------------- Phone T __ .. ' �-- � '�_ -r 1 Address-----------•-------- -'--�-------��G°�J(_��-�----------------• �_._---" Z----- --------------------- Contractor's Name------�_ i ----ice z . __t---------------------------------------------------------------- ---------------- Phone,:4�"e_4<-Z... Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living unifs:v_` Number of bedrooms-._3___ Number of baths _7___ Lot size __7._37__y?X-----/P _-______-______________ Water Supply: Public system _ Community system ❑ Private ❑ Depth to Water Table _:65� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 5& Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 91 New Construction: Yes ❑ No k FHA/VA: Yes ❑ No ' TYPE OF INSTALLATION 'AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic❑ Tank- Distance from nearest well-----------------Distance from foundation____________________Material___ ..___ ________-____ --_.___- ...___ ___- Ll �.- _ _ _ _ _ _ _ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Fiel : Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line______.____---•- �, Number of lines-----------------------------------Length of each line------------------------------Width of trench--------------.-------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well.'7kff;�__4S'.___Distance rom foundation_____��.f_-_._.Distance to nearest lot line____a._-______ F ,-. , ] L Number of pits-----.---I-----------Lining material ----:- -_ .---.---Size. Diameter---------r-�- -Depth---------- `�-----------•--- f % Cesspool: Distance from nearest well-----------------Distance from foundation____.____________.Lining material_______.___________________._________- t ❑ Size: Diameter------`' --------------------------- Depth---------------- --------------------------------Liquid Capacity- --------------------------gals. � 1 Privy- Distance from nearest well------------______;....-------------------.____:-_-_Distance from nearest building-----------_.--------------------------- ❑ Distance to nearest lot line---------- -----------------------------------i----------------------- ------"------•------------------------------------------------------- "fir Remodeling and/or repairing (describe):----------- J i ---------------------------------•---------------- -------------------------------------------------------------------------------•----------------------------------------------------------------------------------- -------� I -----------------------------------------------------•------------------------•----------------------------------------------------------------•----------------------------------------------------------------------- - 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 regulions of the San Joaquin Local Health District.AI - 1 �_: E:� —' ________. Ow rand or Contractor) Lr (Signed)------------------ --- ----- ----------------- ------------ -------------------------------------------- ( / / w --------------------------------- Title `= ----a----------------- ---- (Plot plan, showing size of lot, location of-Sys tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---- ------------------------------ DATE------- REVIEWED BY------------- - ------- -------------------------------- DATE -------------------------- BUILDING PERMIT ISSUED —= -------------.--•--- ------------- DATE.---------------------------------- { q, __ _._� .-- -- Alterations and/or recommendations:---------- ------ ---- ----- -----------------•-••-------------' � ------ ---- ---- '---1';------ ------------- - ------- --.--'-- ---•' -----..... ----------- - 3 = �1 'Q - - - - = = �.�a` r. `_ a `' ;,`� `'cam-_- - ` -- --------------------------------�I/iV�� c� __ -_ - - 1 FINAL INSPECTION BY:.------ .-------- . - ------------- Date------------------------------ = ;l SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave- 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California rte- }I ES 9 REVISED 9-59 3M 3-'63 F.P.CD. S