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FOR OFFICE USE: s{ ..; (A.q_____________ ;;.._ _c __. APPLICATION FOR SANITATION PERMIT Permit No. ... .. 3 .. --------------------------------------------------------- (Complete in Duplicate) _________________________________________________________ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San J uin Local Health District for a permit toconstructand install the work herein described. This application is made in compliance ith ounty Ordinance No. 549. JOB ADDRESS AND LOCATION__ `- --•c��-L�------' ----- 0-j��=�c�--- f Owner's Name-------- j---- ! C -- ------------------------------ ------------------------------ ---- - Phon 6 d�O Address-----•-----------_-- -•-- ---•-•-� --.._..- = Contractor's Name-- 7 ' s----------------------- -•- - •--- Phone__---------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 2— Number of living units: -------- Number of bedrooms ----___ Number of baths' .�_ - Lot size . !P �---•------- Water Supply: Public system 2---community system ❑ Private ❑ Depth to Water Table l�ft.? Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan r] Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes E� No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank,or cesspool permitted itpublic sewer is available within 200 feet.) Septic Tan . Distance from nearest/well_��_ -Distance from�foundation---1f----_--.Material.L�flXLC3 _______________________ ❑ �~ No. of compartments'--Z--- _.7��--- -A_-:---Liquid depth___4Z_/------------Capacity-14-7-B0-------- � i Disposa jeid: Distance from nearest well#AQ`l�-._.Distance from foundation____I_______________Distance to nearest lot line__________. f Number of lines__. Length______________ of each line_____---- __f�_f.-___.___.Width of trench----__.___02 4t'!_______..___ Type of filter materialp g 0 � Depth of filter material length Seepage P• . Distance to nearest well_-I Distance from foundation._ fl3 _ __._,_____ Q.....___.Di tante to nearest lo� line................. , Number of pits-__._I_______________Lining material----____---,__-__._.-_.Size: Diameter._.__ _. -�- De thA0__L•=F--__-----_ Cesspool: Distance from nearest well-----------------Distance from foundation-_-----------------Lining material------------------- ❑ Size: Diameter---------------------------------- ---Depth---------------------------•-- ---------------------Liquid Capacityi---------------------------gals. p Privy: Distance from nearest wet -------------------------- -------.-------------Distance from nearest building_-----------------------___.---.--__--- ❑ Distance to nearest lot line---------------- ----------------------------------- I arkd/or repa' ing ( cril�e):� --------------------------- Remodeling S - �� - - -------•--------------------- --------------------------------------- - ---- _ _ _____________ ------------------------ ----------- .____..__ 7 ------ --- __ __ ___ __ ___ — ----- -- I hereby certify that I have prepared this app" lication aid A t the work will be One in act dance with an Joaquin County ordinances, a laws,-an rules and re lations of t e San Jo quin h District, f Si ne 1 z g ----- -------- - ------ -�'- --"��• -- - - �----- ---- --- --- --GLo' '---Zr- --- ------------------------------------- ;-��ontractorJ � By:-------------------------------------------------------------------------- ------- -------------------- ----------(Title)-------------- (Plot plan, showing size of lot, location of system in afion to wells, ilaings, etc., can be placed on reverse side). FOR D,EP RTMENT USE ONLY APPLICATION ACCEPTED BY-------- _4---- -------------------- ------------------ DATE____f :__2- - ----------------- -- ---- ------- REVIEWEDBY------------------------ --------------------------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED-----------------------•--------------------------------------- -------- -- --------------- DATE Alterations and/or recommendafions:._.. 2°3�� `— i ----------------------------•----------- ----------•------------------------------------------------ _ � -- ------- ,� - -- - -- - --- - - - - ---------------------------- --- - -------- •---------------- t ---------------------------------------------------------------- FINAL INSPECTION BY: -- - - ---------------- Date- �. ~�- ------------------ ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 'E 1601 E.Hazeifon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 6-59 3M 3-'63 F.P.CO.