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FOR OFFICE USE: --------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..147 -----------------------------------------=----------------- (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 AND�LOCATION------ 4-=�----- /1,4- i . ----/AaeL- --------------------- - -2-C � -rel. _----- -- Owner's Name------- fix{---- -• ------- --------- Phone---------------------- Address----•-----•- --------e '?! Contractor's Name; ..Oel --s •L 7W iG�' rGjI,C- ?'9t�-A_._ . - hone----------------------------------- Installation will serve: Residence 95 Apartment House ❑ /Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J------Number of bedrooms .-_°� Number of baths _1_____ Lot size __ ------------ _____________________________________ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table --? Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe RI Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ 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__----_------_--_---------_--__--------_--____- ❑ No. of compartments---------- ---------------Size------------------- ----.-------Liquid depth--------------------------Capacity-------------------•-- . Disposal Field: Distance from nearest well._SU,__f_.Distance from foundation----/&-,-------Distance to nearest lot Number of lines______-I__________________________ Length of each line___-964R0 r. .Width of trench-__3 °�------------------------ 4 , Type of filter materia ,4_ Depth of filter material----a<_7_ `_________Total length- _ '______________- Seepage Pit: Distance to nearest wel __ ______________Distance from foundation___________________ Distance to nearest lot line_____-__________ -- ❑ Number of pits----------------------Lining material-----------------.------Size: Diameter.----------------------Dept h.........------------------------ Cesspool: Distance f3•om nearest well-----------------Distance from foundation--------------------Lining material ----___________-___._--_-_-_________ ❑ Size: Diameter----- --------------------------- ----Depth----------------------------------------------------Liquid Capacity----------------------------gals. 4- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------l ) ❑ Distance to nearest lot line------------------------- - ---------------- ------------------------•--------- ---------------------------------------------------------- #a Remodeling and/or repairing (describe):-- - ` p�. *a------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- f� ------------------------------------- ------------------•----------------------------------------------------------------------------------------------------•------------------------_-__----------------------------------- ------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------ 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 regulations of the San Joaquin Local Health District. (Signed) • -. .%1. } y 1._,/Y7 ;^-------------------------------(Owner and/or Contractor) i ly. /� i t.h lclr (Title)- = - -------- -- - - •-- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -- ----------------------------------------------------- DATE-- �� Y - ---------------------- i REVIEWEDBY--------------------------------------------------------------------------- ---------------- ------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------_------------------------ ---------•--- DATE------ ---------------------- - Alterations and/or recommendations:------ --------- -------------- -----------------------------t------- ------------------'-------------•---------------••-------------- -.-----•-----------------------•-- ------------------------------------------------------------------------- -------- ---------------------------------------------------- ---------•------------ ----------------- y --- I -------------------------------------- --------------------------------- ----------------- 4 FINAL INSPECTION BY-/� Date C -�� ; - -- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED B-59 3M 3-'63 F.P.CE3.