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f APPLILATION FOR, SANITATION PERMIT Permit No. ---- ----L------------- ----��------_----- --- -- ----- {Complete in Duplicate} e� - 1=W Date Issued ----------------------- - Issued This Permit Expires 1 Year From Date „su Application is hereby made to4fhe 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. 544. , .JOB ADDRESS AND LOCAT�II N--••fy� 14131 __ I F ` - --------------------- ------ Phone-----�'��-�-=E__-- Owner's Name-----f-� � Address_____ ---. _______ Contractor's Name----- - Phone ---------------- Installation --••----•---- a Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:_ _____ Number of bedrooms _.YNumber of baths ------ Lot size ______ _4' _�._U` ------------------- l Water Supply: Public system; Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EF-lHardpan ❑ 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.) F Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material---------------_--------------------------------- ❑ "�`-'�j No. of compartments-----------------=--------Size--------------------------------Liquid depth ------------------------Capacity----------------------- 17ispos F,e '` 'Distance from nearest well.................Distance from foundation___.____.---__---.Distance to nearest lot line________._--_.__. Number of lines---------------- -- -- -'Length of each line___._____.?-r_.�______.Width of french---- r _ l .r f Type of filter material__ __�_Zl}�__"Depth,of.filter material____-lr-__._-.---._Total length---------;ZJ7___---------------_...... s Seepage Pit: Distance to nearest well----------------------Distance from foundation__---__________-.-..Distance to nearest lot line-----------------10 I] Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---------------- •-------------r Cesspool: Distance .from nearest well-----------------Distance from foundation--------------------Lining material----- ----------------------------- Size: Diameter--------------------- - -----------De th------------------�--------------------------=-----Liquid Capacity----------------------------gal s. Privy: F.. Distance from nearest well---------------.--------------------------------Distance from-nearest building--------------------------------_.____.- ❑ Distance to nearest lot line---------------------------- -- -- ----=-------------------------- ------------------------ ----------------------------------- ---------- ti 9 t Remodelin and or re airin � describe :_____--.--'____"._ i g P 9,1 - --------------------------------------• -•-------------------------------•--------1------------- ------------------------------------------------- ;�-----------------------------------------------------------------------=------------------------------------------------------------------------------------------------ I. ---------------------------------------------------•----------------------------------------------------- ------- ------------------- --------=------------------------------ - ----------------=------------------------------------------------------=-----------------------_-----------•-------------------.------ -------- I hereby certify that I have prepared-this application and that the work will be done inaccordancewith San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District- . {Signed} _ _._ _ 1 -__(Owner and/or Contractor) --- = Plot plan, _-_-- sae of lot; - {Title} Y= .. -• { p g notation of system in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT.USE ONLY APPLICATION ACCEPTED B Y.......... ---- � --�`---L�=------------------ - ----- DATE-----`��--------- -----------1-�-t------------------ REVIEWEDBY -------- -- --• DATE-------- -------------------------------------------------- BUILDING PERMIT ISSUED- '`----------------- - -----DATE.------------------------------------- --- _ , r f, . Alterations and/or r`e' mmendattons. ''` z .� -------------- f% ~ _�I_.... ,/1� z_-4- `"' �------- �` �'` `� ---------- - �`t" 4[_�f -' '� �=- bbl`:Svc r —t�C?j- '------ ----- �1: ----------- may' FINAL INSPECTION BY:.-- --•--------- ---tio -may - Date-------- - - ?—----------------------------- Gum HYD SAN JOAQUIN LOCAL HEALTH DISTR� >s 1601 E.Hazellon Ave. 300 West Oak Street 1 124 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 2" 3-'63 F.P. u. ' --- II Q