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FOR OFFICE USE: ------------------:----------------- ------------- -- No. I � ------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit .. ... ........... .. _--- [Complete in Duplicate) M Date Issued y'-=-----------------------------_----------- . r' ------ ..:__ This Permit Expires 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. L-)+-FH FoP Mcg 7 JOB ADDRESS AND L�CATION---ilv` s� - _:r_ I�1fL, D ------ -------- t y Owner's' Name____ u1 K Q '- k "'" ----------- = .°_ Phone Address_____________ ___ ____ Contractor's Name__lT'3Q11.♦ -----------------------------------------------------------------------•---------- ------------------------------------- Phone----------------------------------- _ Installation will serve: `Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ O11+her-❑ Number of living units: _�_;_._ -Number of bedrooms . -_ Number of baths r .Lot'size _______ � -_x •/ •— --------- ------- o Water Supply: Public system 0 _ Community system ❑� Private jEr Depth to-Water Table ft. Character of soil to a depth-,6f 3feet: SandGravel,❑---S-andy-Loam-0 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date,._-__-_j-- - 1 No New Cons#ruction: Yes jZ leo ❑ FHA/VA: Yes ElNo� rTYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank`or cesspool permitted if public sewer is available within 200 feet._ Septic Tank: Distance from nearest well __Distance from foam ation y__ Ivlajenal" -�- No. of compartments__--_ ------------Size 3.•71r -.Liquid depth_ /,-_._.--___.Capacity_.._ Q_ k p Id: Distance,frorn. nearest well.:.l5 .----_Distance from foundation---l�_.____--.Distance to nearest lot line_____.________ _ Len th of each lin .3 - y - .. Dis osal Fie er filter material__-P-0--c-4K-K__De th of filter materiel_._ p a �dth of trench___+j-__�__..__-__ r Number of limes_,_--_"----�---------=- p �, '?; Z ` Type - Tota! length------------f--- k r Seepage Pit: Distance to nearest,well_____._________-____Distance-from foundation_e________________Distance to nearest lot line.________-.___._ Number of pits------`------ -------Lining material--------= ---- -Size: Diameter - Depth ❑ ! x,q p+. Cesspool: Distance from nearest well-----------------Distance from foundation:.............. ....Lining material_.__.____________.____..;__________. Y ❑ Size: Diameter------- ------------------------------Depth-----------=---------------- - Liquid Capacity gals. . Privy: . Distance from nearest well____________________ ---------------- 1Distance from nearest building= .. --- • ti --- ------ ❑ Distance to nearestllot line ----- - - ----- ---------- y 5 "------y------•---------- -- -------- Lsc Remodeling and/or repairing (de # ` - -----------•-------•-------------------- .:. _`.+.vim � # - ------------------------- ----- i ---------------- I --- ------ -- --------------------•---- ------------------------------ 1 hereby certify that I have prep red this application and that the work will be done,in accordance with San Joaquin County ordinances, ;State laws, and rules a regulations of the San Joaquin Local Health District. UA ...,.r ..,.�..,...r.�.�- ...,,.......^s is wn rContractor) _ v r, nd/o (Signed)------'- --- - -- - -- Br y --- ----- -------- (Title) (Plot plan, sho 'ng size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYt- � `--- -------------- - --------------------- DATI `- --- ------------------------- ---------------------------- - REVIEWED BY_ i�" I '- - DATE { BUILDING PERMIT ISSUED_, . = r— m. _.. t t. .� A _ ------------ �_ .. m Alterations and/or recommendations: ------------- ---- - ---------- ------------•-------------------------------------------------------•------- -------------- Q Q "* 1 ------------ --- --------- -•---•---------------------------------------------- -------------------- - --------- ---- -- - FINAL INSPEC Date--------- > - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haaelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ,Manteca,California Tracy,California '.V�'E5 9 REVISED B-54 3M 3•'63 f.P•CLI. _R