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FOR OFFICE USE: _�- = r C"`f-------------- 7 3 APPLICATION FOR SANITATION PERMIT Permit No. .............. - -- v (Complete in Duplicate) / / = - ---.-_ _ --------p. This Permit Expires 1 Year From D Date Issued _�f =S/ _ ate 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---------------------------- - - - - - ------- -.------------------------------------------- Owner's ..._-----•------------------------------- -c.- -c��u--------------------- --- ---------------------- --- ------------- Phone-•---•------------------....-------- J Owners Name------------ -- ----------- ' ;------------------------------- ------- Address. T�' c7 l/ �1� 1 � --- - - ----- - /------------------ •------------- --------- Contractor's Name---------L�- .'. JrlG'-_ �' _ ` Installation will serve: Residence E Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ; Number of living units: _---- Number of bedrooms - __ Number of baths _1---_ Lot size _____7_' �' - - ---_- Water Supply: Public system V-11community system ❑ Private ❑ Depth to Water Table -------- ft.- Character t.Character of soil to a,depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay'[:] Adobe 0--Hardpan ❑ Previous Application Made: (If yes,date--------------------) ,No E] New Construction: Yes ❑ FHA/VA`Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well____. °___1Distance from foundation--_f__� -. Mater' No, of compartments....... . _._ ��'"� "•� Li 'd p, Capacity.-,I - ��----JSize----------------��-----•------- qui de tn------_-- �---=--- -- Dispasal Field: Distance from nearest well_? ____. 'Dp�nce from foundation/--3�'"--------Distance to nearest lo; line--__- �- Number of lines------ ____.____`Length of each line_1R_ _____________ Width of trench---.-_�-_.,..._f_--.-_---__--- Type of fllter'material._ _--__Z_.____Depth of filter material----- -----_ Total length-----.:' � -------___-_---_ Seepage Pit: Distance to,nearest well___________________ __Distance from foundation---------------.___.Distance to-nearest lot line-__----_.__--._ ❑ Number of pits------ --------------Lining material----------------.___---Size: Diameter----•-------------___--Depth-.------------------------- _ -- 0 Cesspool: distance from nea sf,well-----------------Distance from foundation--------------------Lining material------------------------------------- \jj ❑ Size: Diameter_ )------- ------------------------Depth------------------- --------------------------------Liquid Capacity--------------------------gals. 0 l Privy: Distance from nearest well------ ----------- ------------------------------Distance from nearest building------------------------------ - ------ `•(r ❑ Distance to nearest lot line- --------------------------------------------------------------------- -------------- -------------------------------•------------- ------ Remodeling and/or repairing (describe)- ------------------------------------------------------------------------------------------- ------------------------------------------------- -----• C --------------------------------------------------------------------------------------------------------- •------------------------- - ------------- --- -- - _ - -----------------------�----`-------------------------.--'----------------------------------------------------------------------------'------ - -- . . hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' ordinances, State laws,'a d rules and regulations of the San Joaquin Local Health District. I (Signed]-----x- it�� ---------------- --------------------------- ........(Owner and/or Contractor) �' "f�_." .�-� (Tit e) t By• L`� ------------ -- - --- ---- ----------- (Plot plan, showing sizef lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION.ACCEPTED BY...__ - - --- ------ DATE------ (' .. REVIEWEDBY------------------------------------ -------------- --- -=--- --------------------- ---------------------------------------• DATE------------------------------------------------------------ BUILDING PERMIT ISSUED ------- ----- ------•------- -------------' DATE - Alterations and/or recommendatiorAs: ---� 1'--------- -�.�- - -- y� T-- - i -------------------- --- e c7 ex -may �c �r-� �'Z_ f�P. C� -- -----� ----; ` ---------- �4 ----- �� - /�� 7 yt--, (�-t---�- e ' ��..�-•----- a.r+'C _- <n�-•Z�- d-C-•c G ,A 1J - ------------------ -------- -=-- '----------------------------- ----- '• ------------ FINAL INSPECTION DY:. ------- t ' ---------`- ------------ SAN ---------- S N JOA UIN,LOCAL HEALTH DISTRICT Y 101 E.Hazelton Ave./Z_0 o� "t Oak �f5 west 9th Street �L �--Ladi,California Mant ca, COW di, I r cy, i{p»riaQ._^f21 �r� Stockton,California V z. 4-r- LQ =� �r �� *-�L�-cr 1f..� � =o-+.�'lf` •rte-,-.-r'a ES 9 REVISED 8-54 31A 3-'63 F.P.CO.