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rUKVrrlLt UZ)t: 1 ------------ ------------------------------------------ --------------- --------------- ------------ ------------ APPLICATION FOR SANITATION PERMIT Permit No. /74• O ------ ----- -------------- --------=----- --------- (Complete in Duplicate) l,�1Y/ --------------- --- ------------------------- ------ This Permit Expires 1 Year From Date Issued Date Issued _�L-/o Application is hereby made to the San Joaquin Local Healfh 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 DSL ,CATION__P? f / Owner's'Name-------•---- -Fl Address---------------- .` ----`--•----- _ox------ Contractor's Name- - NTEi- }- _ �'"' [ [ �. .. _C ....... Phone......................------------- Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ P' Motel ❑ Other ❑ 1 L.� f Number of living units:•_-- Number of bedrooms .,2--Number of baths __[----- Lot size .--�Y_q90 . , l 7 Water Supply: Public system ❑ Community" ommunity system ❑ Private 94-'bepth to Water Table/:�-- ft. Character of soil to a depth of 3 feet: ISand ❑ Gravei ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No 21-' New Construction: Yes V�<o ❑ FHA/VA: Yes ❑ No ®~� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . r Septic Tek: Distance from nearest well---- - ..--Distance fron.1 Nc-. _ -- -- fi =r- ------- No. of compartments{-----------------Si7e`__�..�..-X-�--� Liquid depth_--_Y��--,--Ca acit �� l' Disposal Field: Distance from nearestl well _a_-_Distance from foundation__- ....... Distance to nearest lot _---___-: , [ ly Number of'lines-7_� !r----- ------Length of each line--l��_ _ ar ._.Width of trench.-- }__�---e,< -� Type of filter material`_AC,A__---_De th of filter material-- ` � 7 t t. r� p - --------- -Total i length-------------` - ---- Seepage � ----------•--- Pit: Distance to nearest well-__..:c___-----._Distance from foundation-------------------.Distance to nearest lot line----------___ ❑ Number of pits.................I_Lining material------------- ±----Size: Diameter-_-----------_- _----Depth-------------------_--- -------- 0 Cesspool: Distance from nearest.well_--.--_-_I--___Distance from foundation(-,_ _-_----. s r Lining material-----------------------------------. ❑ Size: Diameter ---------- ----=-----------=--Depth----------:-------------- Liquid Capacity gals. i.G Privy: Distance from nearest well__--- - -------------------------------Distance bui from nearest ldin --- 171 Distance to nearest lot line _______________ ---------------------------------------------------------------------------------------------- Remodelin and/or repairing describe ------------ l --------------------------------- ----------------------------------------- ----------------------------------------------------------------- ---------------------- ---------------------------- I l ; I hereby cert' that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, Stat I ws, nd rule regulations of the San Joaquin Local Health District. (Signed)- (Owner and/or Contractor) BY: ==----••-------- ---- =- Title -------------------- --------------------------- - -- T. .--. (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 •-f 4_%--Q-------------------- - - --------------------- DATE------, - ------- --------------- ------------- EVIEWED BY ------------------------------------ -----------------------------------------------------------•--------- --------- DATE BUILDING PERMIT ISSUED--------- -----•-------- - --------------------.A_ DATE_----- - 1------------------ - Alterations and/or recommendations:- .--Z ---`-- � --�;;�-------------.��_:_ ------------------------------------------------------------------------- ------------------------------------- ----------•------------------------- ----------------------------- a- L- -------------------- ......--7--------------------- M ------------------ FINAL iNSPEC'TION, BY: ----_---- ----- ' `, Date - -------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 3M 3-'63 F.PX0.