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FPR OFFICE USE: 3/±3 f_7 -----------....... ,_ APPLICATION-FOR SANITATION PERMIT Permit No. -_X_f-_- _l. ----------------------------------------------------------- (Complete in Duplicate) ------------------------- This Permit Ex ires 1 Year From Date Issued 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 Count Ordinance No. 549. JOB ADDRESS AND LOCATION_f- __ ----------- ---------------- 'n.Q-- Owner's Name-------- --- ---- -------- ---------------------- - ---------------------/-------------- ------------------------------ ------------- Phone------------------------------------ Address--------- -----------•------- -- ---- �'►�_ -------__t_r� .._-------------- - - - - - - - - Contractor's Name_ Phone ------------ ----------------------------- --•------- Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1----- Number of bedrooms __,2,_ Number of baths _1___ Lot sizexl-d� Water Supply: Public system Community system El Private ❑ Depth to Water Table .-4aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa dy Loam E] Clay Loam F) Clay ❑ Adobe�Flardpan ❑ Previous Application Made: (If yes,date____________________) No VNew Construction: Yes P-IN, ❑ FHA/VA: Yes ❑ No 0— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Sept- ank: Distance from nearest well---_—�_-----Distance from foundatior/o___-----------Material_ ____________ ______ No. of compartments.__Z-_. Size_ ?C a__ ________Liquid depfk1--- ------- ,..---------Capacity_-/ -------v /{ Disp Field: Distance from nearest well------__..____._Distance from foundation.L,v_____._____.Distance to nearest lot Iine,S/._____- Number of lines.--------I------------------ Length of each line____t��._________________Width of trench 2 ----------- ---------- T e of filter material___�_��_4_- S 'I -------- Type .___.___Depth of filter materral-_��____ Total length_.-- _________._]_.�____.____-- I� Seeit: Distance to nearest well___.—_____.....__Distance from foundation___ld----------Distance to nearest lot line____`�__f___- Ln Number of pits------r--------------Lining material.-7P(�A_ ____Size: Diameter.___`42.......-----Depth_.__.�_'J --------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___.-_____________..__-------------- - .. ❑ Size: Diameter--------------------- -- ----------Depth------------------------------------- -------------Liquid Capacity- --------------------------gals. A Privy: Distance from nearest well ______________________--------------------------Distance from nearest building.____--_--____________________.____.__._. ❑ Distance-to,nearest lot jine------------------- �-T-----------------•-------- --------------------------------------------------------------------- I ' Remodeling and/or repairing (describe)_-------------_---------------------------- ---•-------------------------------------------------`-------=---- -•--------------------------------•------------------------------------------------------------------------------------------------------ -- �p ------------------------------------ ------------------------------------------------------------------------•-------------•------.-•---------------__------•-------•-------- --------------•--------------------------- ---- l ---------- ---------------------------- ----------------------------------------- ----------------------------------------------------------------------------------------------------------------------- ---- ------------- I hereby certify that I have prepared this ap lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and latio of the San Joaquin Local Health District, t .. (Signed) - --------------------- ------------------------------------------------------------------------------(Owner and/or Contractor) 9 ) By:--------• --------- -- - - - ----•----------- --- -----------------------------•----------------------------(Title)------------- --- - -- (Plot plan, showing size o of, ocation of system ` relation to wells, buildings, etc., can be placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_---- ----_____ 7 ----- ---------------------------------------- DATE---Y REVIEWEDBY------ ---------- --------------}------------------------------ ---------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------ ----------------------------- DATE------- Alterationsand/or recommendations:______/�'t �� __...•_____--.- _�--� ' _` <= _�� �, �~_ r �i Y e�j E r/-.. `�' -+ e , - —t `; J j.Fit: / --,--------- r -rr ------- ------------ ------------ tj r-----�-`�--------------- - •------- -----�--- --- - --�- - ------- 7f44=---- - —rte t '•--------------------- -_ -- ----------- T �L�,-t---------' ~f'--•-------------- c �..-- -- ----- -=----• ----- - .--/ -- -------- ---- -- -C-t- `---- ---�va------ ---",�-rR------`-- -6-=~~`7�----•�l-4 (�CC 2f, ,` s�� FINAL INSPECTION BY: C/L� 61 -----------• Date--. S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 30 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CO. r