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FOR OFFICE USE; _.___...... -----------------------_ APPLICATION FOR SANITATION PERMIT Permit No. ........................ ------ . ---------------------------- C ---- am late.in Duplicate) r { PDate Issued ------------------------- ------------- -------------------- This Permit Ex ices 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------ P '-------. ------ ------------------------------------ ---------------------------------------------- Owner's Name------IJt-C D ---- ---S------------ - p--1---!:nl�---- - _ Phone W_-Q---`a-6 I ,,. Address_. _- = ° •• / e.( _[_ l'------------------------------- -----------•--------- --•-----•- Contractor's Name-------- _.__t ......�J-1 _f� _LS.L'1------------&Q-14-4------- 1 N-��------------- ---------------------- Phone---1-46-0 9.-h Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel p Other Number of living units: --I---- Number of bedrooms _ Number of baths ---C__ Lot size __._.� ---2-0-2 . t 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 0- Hardpan ❑ Previous Application Made: (If yes,date------ - I No [or" 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--------------I-----Material -._______.___.____.___....__.-_______..___.___.. } [] No. of compartments-------------------- _size---------------- ._-.__-- ------Liquid depth--------------------------Capacity---------------------- Disposal Field: Distance from.,nearest well..i---------------Distance from foundation--------------------Distance to nearest lot line_--.-.___---__--- ❑ Number of lines--------_----------------------_______Length of each line-------------_._ -------'-----Width of trench------------ ---------------•--- • i Type'of filter mater.ial__________________________'Depth of filter material_------..__.____-._._._Total length__..._._._._________....______':____.._-_ r , � r Seepage.Pit: Distance to nearest welf`_IVQN�_D.istance from foundation____111-_.�._._Distance to nearest lot line________-_-_.. x t [� Number of pits______`_/-._-------'Lining material__ ---Size:,Diameter------C3 ------Dept h--------- -------------- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material--------------------.---_--- ❑ Size: Diameter.__'-------- ---- ----------------Depth-----------------r----------------------- ---------Liquid Capacity-------r----------------• --gals. Privy: Distance from.nearest well---- ----------__--------------------------------Distance from nearest building---________-----__.._--________...___-_. Distance to nearest lot line-------------------- ----------------------------------------------------------------------- Remodeling and/or repairing (describe):-____- ---- yC9_----1._:-X6C7_1,S/6___... f'-�S--T _.------ ----------------------- . - ----------------------------------------------------- ------------------•---------------------------------------------------------------------------------- -------------------------------------------.--- _ __ __ t certify = = _ I hereby -------------- that l have prepared #his 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. ., --- � t Il ,� t so (Signed)-------- ---- t'Z'-•'---•--- --------- ----- -- - -------��-�---- ..�-�,.-}..r_-- �,,...�--------------- --------(O ner and/or Contractor By:----------�r------ - s -------------------------{Title)--------- ----------- (Plot plan, showing size;of lot,.locatio system in relation to wells, buildings, etc., can be placed on reverse side).: ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------I_C._r_-._�r�C.G�...-_- € ---=.------�-------------�----------------------'-- DATE-----<�------- ------- -------•------------ �----- REVIIWED BY ------------------------------------ ------------------------------------- --- ------------•------------ --� DATE------- -- - ----------------------------------- BUILDING PERMIT ISSUED: -------------- - E-------------------------------------------------- DATE --------- .................Y, Alterations and/or recommendations-— "---- --------------- -------------•-•-------------•--•-------------------------------------,: ---------------------• - ->-.1-._ _- f' �3 -r - • __'n ------------------------- , - .� .� - = ........ - -------- ------------------------------- - FfNAL INSPECTION BY:.-------- -�.C'� ------------------------ - Date------ ,� ! ..F., SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naselton Ave. I 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California s Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3•'63 F.P.0 C. ,fly T