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FOR OFFICE USE: ""- --------------- ----=----------------------------------- - / Permit No. -_/--� -•=� APPLICATION FOR SANITATION PERMIT qq -------------------------- ---------- -- --------- (Complete in Duplicate) �3 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 appljcation is made.in compliance with County Ordinance No. 549. —15 JOB ADDRESS AND _CATION. =r"��, = f .� _� T -- - U - • 1 --,ftt1 Phone h i , i ------------------- one------------------------------------ Owners Name i `� w� o4 Addressr �' ` ----------------------------------------•- . ------------ 1 Contractor's Name ~ L t ----------------- Phone----------------------------------- 1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----I--- Number of bedrooms - Number of baths _� Lot size __� -- - - Private pe to Water Table -_ ft. Water Supply: Public system ❑ Community sy tem ❑ Frt r_��_p Character of soil to a depth of 3 feet: Sand Grave{.[]..-Sandy,Loam-❑. Clay,Loarn❑ Clay ❑ 'Adobe❑ Hardpan ❑ Previous Application.Made: [If yes date..................4_) No -'New Construct ion:, 1� IVo ❑ FHA/VA: Yes P11' No ❑ TYPE:OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted-if,public sewer is available within 200 feet.) Sept c .ank: D stance from nearest well_.. --Distant . fro foundation__._!-✓�_ __'_-Ma teal_.. _ _ - ...... ----- No. of compartments______ '~_--.--Size__. ___ - --X-r-�---=Liquid depth__-' _/�;------Capacity__. - J / —' -:Distance to nearest lot line____ ___________ Disposal Field: Distance from nearest well•-.�„(�' ._Distance from foundation � ,. �!1 � Number of lines__ __-----------------Length of each lineS, -5P!!_�_ { --Width of trench.._._ _____.__ 4 Type p l �� Total length-------- --- - - ------- T e of filter matenal._ �? Depth of'filter material_ ' x Seepage Pit: Distance to nearest well ---------------Distance from foundation .__ w F Distance to nearest lot line------------------ Seepage ___.___.- ._ }� mber of ❑ Nu tante frorrisnearest well Lining rtID stance fromifoundationDiamet'er Lining mat Depth—------- --------- F Cesspool: Dis ❑ Size: Di�titer-----------------------------------Depth_.-.................---------------------------------, Liquid Capacity --•-------1-----------,--_gals. I Priv Distance from nearest well------- ___. .___ _- Distance from nearest building y: ❑ Distance to nearest lot line _--” - "�-""-"' ------------------------------------------------- I ----- -�i '�- � - ----------------------------- ---------- ----- C Remodeling and/or repairing (describe)----------=---------- --;:---------------- - - L.. �� p !, -�.'�f l• ' F--------------------- ----- ------ 4 ----------------------------------------------------------- -------------------- ---------------------- 11n # ` � , , . i I hereby certify that I have preperddlhis application and that the work will be done in accordance with San Joaquin Coun#y ordinances, State laws, anti rules and regul tions of the San Joaquin Local Health District. .. �- 1 an % r Contract {Signed),- . , l - -------- --------------------------------- ----------------- - --- -- �� ._,_.. .. r----- -O -ci o 0 -0 #B . ------------------------------------------------------ --- [Title}_ __ . Y•-------------------------- _�:_�--�---- ::._� � � [Piot plan, showing size of'lot, location of system in relation to wells;buildings, etc.;can be placed on reverse side}. i F 1 f FOR DEPARTMENT USE ONLY lAPPLICATION ACCEPTED BY---- 1----I- -c..0,-------- ----- --------------------------------------------------- DATE-------- - ---��-------------------- •. ---------------------------------------------------••• DATE-------------------------------------------------- - --- REVIEWED BY-'_----------------------------------- - ---- -':----- ------ -- ` - -- BU1LD.lNGrP.ERMl7 ISSUED=-------== ---------�___- =_-------_ -_-___-,DATE: =_^= - =---------- -::--w`� r= _E �-1 _ Al#erattoris and/or recommendations------- - - --- -------------''------ --•--oP��_�1_�_. _.�751�------�--1`��"f`J_-1`�C!- -------~--•-C---��.--T-------- ----------------------- q_�1.Z-6�3------------ ------ -�Sqy------ qt C? ------------------ ---------------- ----------------------------------- ----------------- ----------------- ----------- R -----------•------- -- P - i - ------------ -------------- ------ -------------- - --------------------- FINALINSP .. ._ ----------- ----------- Date------------- -/ �--©-------------- --- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamare Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD.