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FOR OFFICE USE: ►� s `� ------------t-L---5 d------ 6 -------.----P=----------------------�,:&V--------- APPLICATION FOR SANITATION PERMIT Permit No. .....f�_755 ------------------------------------------------------ (Complete in Duplicate) - This Permit Expires 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 Ordinanc o. 549. JOB ADDRESS ANPOCATION--- b - tet ------------------------------ ----------------------------------------------------- Owners Name-_ Z -- Pl�•w� .__- ------ Phone---------------------_------•---- Address--------- _v!�,.._L.1�-f+� l✓ = Contractor's Name-------r_ ----------- --- ---------------------------------- Phone..................................• Installation will serve: Residence ,[Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .----- Number of bedrooms .. Number of baths -1..-_ Lot size __-. -------------- Water Supply: Public system B--community system ❑ Private ❑ Depth to`Water Table 4�P__'ft. .Character of soil to a depth of 3 feet: Sand E] Gravel ❑_Sandy'Coam [I Clay Loam ❑ Clay [j Adobe"�ardpan C] Previous Application Made: (ifyes,date--------------------I No New Construction: YestT-No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well..` ^--Distance from foundation_,/0__r.......Materiaf... .... No. of compartments..__29—_ = Size---3�5-77'5------�-------Liquid de th-...-..A -- - -- -- Disposal Disposal Field: Distance from nearest well---- '..-.-.Distance from foundation.---,<{3-{-..---.Distance to nearest lot line.-.. ...__�.. Number of lines---._ .._._-. Length of eachkline__ ,0 1 9 � -------------�--------Width of trenchp- - - --j---------------- Type of filter material---7 .0.__4_�t.Depth of filter material--le length---,/�__...._..._------------------- Seepage Pit: Distance to nearest well--------.-- Distance�jiom foundation---Z ---C-.._.-.Distance to nearest lot line-.2557_.. _ + ®� Number of pits------- ------------Lining material_ I1G -----Size:'Diameter-----Z-�?n-----_-Depth-------Z. '------.___- .r Cesspool: Distance from nearest well.................Distance from foundation--------------------.Lining material----__-.------..-.-..----------------- ❑ Size: Diameter Depth -'--- --------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-.__--_.___________-------------------.--- t ❑ Distance to nearest lot line--------------------------------- -------------- ----------------------------------------------------------------------------------------------- i _ Remodeling and/or repairing (describe): -------------------------------------------•-------------------------------------------------------- (�� -------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- -•------------------------------ 'Y -------------------------------------------•- •----------------------------------------------------------------------------- '----•---•--------••------------------- ------------------------------------------------------ --------- ---------------------------------------------------•------------------------------------------------•----------- ------------------------------------------------------------------------------------------- ------ 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, a�ros and regulations of the San Joaquin Local Health District. r (Signed) (1]*rter-aosVar Contractor) BY:------------------------------ - - =•. = -- i- -------------(Title)---------------------------------------- - l ------- (Plot plan, showing size of lot, location of,system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- .r-- -.,r-c<d!-----------------------�---- ------ DATE------.---- - . .- _ f -- - ---- ---------------- REVIEWED BY------------------------------------ -------------------- ------- DATE----- -- -- - ------------------ -------- -------------------------- ------------ -----•---------�------- ---------------- BUILDIN9 PERMIT ISSUED---------------------------------------------------------------•--------------------------------------- DA-TE------------------------------ ------ ----------------------- Al of s d/or,reco mendafi ns:------------- ---------- ----------- ------ � � - ------------ ------- - ----------------------------------------- . — -------- ------------ ----------------------------------------------------- --------------------- -------------- -------- ------------------------------------------------------------------------------- -- ------------------ ----�lrls�..--— ----------------------------__ ---._.-...------------...-----._------..-.......----__--------._._....--------....__----------------. ........................................I-----------------------.. - --------------..-----._._....._-.._......-..--------_.........._......-.-.-.-_.-....._._....------------------------- .---------..------------- - r FINAL INSPECTIONBY:---------- Date ' 6 --- ----------------------------- 'R SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th,Street Stockton,California Lodi,California Manteca,California Tracy,California I CE 9 REVISED 8-59 3M 3-'63 F.P.Ga. 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