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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. i--- --------------,! ----------------------------- ---------- -- ---- ------- �. (Complete in.Duplicate)- ., .� 1�. ... Date"Issued -------------- -. ..................................._ tThis Permit Expires 1 Year From Date Issued f=a ry Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the workierein described. This applicatiori is made in compliance with County Ordinance No. 549. /yd 2 JOB ADDRESS AND LOCATION _T ---------�_--=-`3---------(------------------------------------------------------ Owner's --.S'f-�7�--�~----•------ I Owner's Name.- = ---�---•----------------------------•---------------- -- Phone ' Address---- ----------/-7- --------------•------------------------------------------------ Contractor's Name--------------- ./��` ---------••----------•------------------------------------------------..--------------------------------- Phone-•----------------------- ------ Installation will serve: Residence 1A {{ Apartment House ❑ Commercial [V Trailer Court ❑ Motel ❑ Other ❑ !Lot / �i �.. _ Number of living units: .�Number of bedrooms ---�.. Number of baths .�_ t -------- size •-- Water Supply: Public system ❑ Community system ❑ Private 0 Depth to.Water Table .l_2"ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--.--- ------.------) NoM--.New Construction:�ye,�7No ❑ rFHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: � -� -4-(No septic-tank;or cesspool-per mittedrif-public`sewer-1va"ilalilti wifhin-200-feet:)� Septic Tank: Distance from nearest well------.-_---------Distance from foundation-------------------.Material---------------------------------------..------_. 1" No. of compartments- -----------------------Size--------------------------------Liquid depth--•-----------------------Capacity----------------------- Disposal Field: Distance from nearest well----- ------Distance from foundation-------FV-----------Distance to nearest lot lin _7-t5_.__.-.__. Z - Number of lines.... --.•--------- ----- Length of each liner .C� "_.�.- ..j --.Width of trench__.._2.�_..----------------- '`) �, I'vType of filter material_,__ z�� ._r i 1-j -1 -Depth offilter matenal--- ---- - _.-Total length-----JJ --- ---------------••------ Seepage Pit: Distance to nearest well----------------------Distance from foundation...................Distance to nearest lot line_........-_._._. ❑ Number of pits------------------ Lining material-------------------_--Size: Diameter-------------------.----.Depth--------------------------------- Cesspool: Distance from nearest well........... .:.Distance from foundation--------------------Lining material__----------------------------------- Size. .._.___------ .._.-.Size: Diameter------------------------- ------------Depth.-- -----------------------------------•----------Liquid Capacity-----------------------------gals. //�► ear D -t- � - - �'� Distance from nearest well._.__ _-. ± ------------------------- Privy is ante fromnearestr6u�ding.......--------- ._.._...... "` ❑ Distance to nearest lot lire.------; ---------- ------------------------•--•-•-----I-------- - --------------- ------------- ------------------------------ a a f= , Remodeling and/or ,repairiin��lllg/(describe):.--_ - -l�nCl- r�/!F.)s �� 722 .._C f7:�. � ` � �. v/ 1 ' '=�1 _. .-_.. ... ..f�._cf /Y C ' . feS1 - _..5-zr.._._ t�E� -.- _ _ E 1_ rf1 ZJ--------- C � - ------ -• —c +�.1 . - ---------- r --- ------- 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. ------------------------------------------------------------ [Owner and/or Contractor) By:---�;;;_:------- ---••------------------------------_--------- :.F-: --.- ----•------------(Title)--- _ ------- --: ------ -- -- (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----------------------------------------------------------- - DATE----- ff ---- -------------------------- REVIEWED BY-------------------------- ------------_----------------------- DATE f . ' BUILDING PERMIT ISSUED - - -, - ----=- DATE.. � ---------•-- , - Alterations and/or rmmend tions:-_ zC'- _ __. Csz -- ?` r----- J �'-` -• -ter ---- f ` ---- ` ----� ----- ---------------------------- --------------------------- --------------------------------------------------------------------------- - -- _�1�d�i :--- Date- - -1�-�-.t.�-�-� --------------------------------- -------- FINAL INSPECTION BY:. -------------------- - - ------ --- - SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street t. Stodclon,California Lodi,California " T Manteca,California Tracy,California E$ 9 REVISED 8-59 3M 3-'63 F.P.CO: