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FO.K OFFICE USE- .............. _ 1� . APPLICATI.OW FOR SANITATION PERMIT Permit No. ...... . "� (Complete.in Duplicate) -----------------i_ .- - I -------- - . � Date Issued -------•- ---...._-�j3 , -.?------- ----- --- -This Permit Expires 1 Year From Date Issuer Application is hereby made to the San Joaq Local Health District for a permit to construct and install the work herein descried. This a .ye mad • co 'County Ordinance No. 549. JOB ADDRESS AND L CA ON:.y- -..__a- <._ � - - �-- =. - - -- Owner s Name---------- V11- ----------------- 11 - ------ Phone--------- ----------••-----•-------- Address <-- ti ' ----------------- ----•--- - ---•------------------- Contractor's Name-------- 7----'-'-"_"- -----------------------------------=-------------•---------------------------------- Phone----------------------------------- Installation will serve: Residence [[Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J_-- Nurnber of bedrooms_9--- Number of baths A_ Lot size ------------------------------- if Water Supply: Public system [ICommunity system [IPrivate e"Depth to Water Table , ft. Character of soil to a depth of 3 feet: ISand ❑ Gravel`❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date.... ..............) No New Construction: Yes �No ❑ FHA/VA: Yes E'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..... Q_-_--------Material -- --0---------.- ----- ---- ---ti'/ No. of compartments--- ---.--•---- --_Size � -Liquid de th---- CaPoutYzlzle�? Disposal Field: Distance from nearest well--------------Distance from foundation----A55�-........Distance to nearest lot line.)O_-.---__--. � 'l l Number of lines--------Z---------------_--_/_�--,,Length of each line-_-_ ,e -- -_----_----- Width of trench-.,V--_.-------------------- _4 ------------.---. 1 , Type of filter materiaL� _- G _Depth.of filter material---.. - --------Total length----- - ..,_-.___ -----.- `rjJ t i [: Seepage Pit: Distance to nearesfi well---14949_-----_Distance from foundation-_ ---------------Distance to nearest lot line-_4---- Number of pits._,2------------ Lining mate rial_-,eO.6461--Size: Diameter_ --------Depth_,2W1 Cesspool: Distance from nearest well__ _'1--------Distance from foundation--------------------Lining material----.-.-----.--.------------_-------.. ❑ Size: Diameter---------------------------" Depth------------------------ ------------------- ----Liquid Capacity----------------------------gals, Privy: Distance from nearest well.--__----_---------------------�_----------------Distance from.nearest building------------------------------------------- ❑ Distance to nearest lot line--------- ------------------- ---------------- ------------------ --- -------------------- --------- h ' Remodeling and/or repairing (describe):---- _ - :% -------------- ------------------------------------------------- l-1 ern ----------------------------------------------------I--------------------------------- w . ` ----------------------- F4 1 -------------------------------------------------------------------------------'-------------------- State -------•--___-___----_-___._.__--------_-------- _•_---_.---_-----____•_-"-- --s- - 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. ! -(�r.Contractor) (Signed ----------- = _ _ ------------------------------- B f. .._(Ti le) t _ Y:----------------- ---------- ----------------- t 41.r (Plot plan, showing size of lot, location of syste In relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY---- •- ------------------ ---------------------------------------- DATE------ -- ----------- REVIEWEDBY----------------------------------- --------- ----------------------------------- -----. DATE------------------------------------------ ----------- BUILDINGPERMIT ISSUED-----------------------------------------------------------•-- -------------------------------------- DATE-------------------------------- ------------------------- Alterations and or recommendations:---_----- _.....--.- . ---------------------- -----=--------------- ------- �� ------------------------------------- -----------------------Ig --•------------ ---------------------------- -C-. ------ l� --; �-- --�------ ---------- -------------------------- FINAL INSPECTION BY: , ! /_---------------------------------- ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISED 9-59 3M 3•'63 F.RCC.