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F R OFFICE USE -------_---- _____------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. .. (O --------------------------------------------------------- (Complete in Duplicate) Date Issued _________________________________________________________ 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 AN LOCATION__- _ _ __c)---------i� &-;, Owner's Name _ ------ ---- ----------- :.. -------• -- --------------------i------------------ - -------------------------------------------- Phone..........•----•------•-------- Address---- ----`� ----- -- - • __ - --------------------------------------------------------------W- ------•-------•-------------------------------------------- ------------------------------------------ - - Contractor's Nam --- -------•----• ------------ ------ ------------------- -------------------------------------------------- Phone----------------------------------- Installation will serve: Residence Er-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- Number of bedrooms__ Number of aths __2- Lot size &9'x A,P Water Supply: Public system E] Community system ElPrivate Depth to Water Table&_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Eq--+4;&-rdpan ❑ Previous Application Made: (If yes,date---------------------) No New Construction: Yes E5"-No ❑ FHA/VA: Yes,❑ No fl� TYPE OF INSTALLATION AND SPECIFICATIONS: Y (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest we4-_0_-r__...-Distance from foundation_ k__ ___.___Matje ' a!___ !- .^ n _ No. of compartments_---------�- _-___-_-.-_Size---- r ---Liquid depth- ------ --- Capacity -p----- Dispd: line Distance from nearest we 111'510 Distance from foundation-/d------ -------.Distance to nearest lot line----------------- Number _-_ --------.Number of lines.__.____ _ Length of each line______ Width of trench__.__.-_g------------- --- -------- --- --------------------------- Type - T e of filter material___.._ l-- ----- yp ____Depth of filter material--Ir Total length__.l _____-4-_______________________ Seepage Pit: Distance to nearest well./_6' _______piston foundation__/�------------Distance to nearest lot line__'__-- [�� Number of pits------- Lining material___ Q.C.t-_.__.Size: Diameter-3-3---k---------Depth------ '--------___.._ Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material____...._-.-..-----._--__.-______.- ��,,,,,,��' •. ❑ Size: Diameter------- ----------r-------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F1 Distance to nearest lot line--------------------------------------------------------------------------------------------------- Remodeling -Remodeling and/or repairing (describe)-------- ------- -C.`'�'� Q'_ z1' � 31_. / --------------•----------------•-------------------------------------------------- ---------------------------------------------------------•-------------------------- ---------------------------------------------------- ---------------------------------------------------------------------------- --- - - --------------------------------------------------------------------------------.------------------•.------------------------------------ p ----- ------------------- ----------- --- ------ ----- ----------------- -- ------------------------------------------------------------------------------------------ ------------------------------------------------- I hereby certify that I have prepar application and that the work will be done in accordance with San Joaquin County ordinances, State la d rules re ons of the San Joaquin Local Health District. (Signed) - ----- - --- --- - ------� --------------------------------------------------------------------------------(Owner and/or Contractor B (Title)_ Y• - ---------------- --- -- ----- (Plot plan, showing size of to , location of system in re ation to wells, buildings, etc., can be placed an reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ t ✓----------------------- -- - 20 DATE -------- REVIEWEDBY--------------------------------------------- -------------------- ----------- --------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------- -•----------------------------------------- DATE------------------------------------------------------------- Alterations and or eco a ati ns:------ ---- - --------- r- - ---- . -r-� _ ------------- -------- r ---- --------------- �� ----------- c�`91 ---------------- - FINAL INS ECTION BY:--------- -e'�------------------------------------- Date ?- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVISED 8-S9 3M 3-'63 F.P.CD. u