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FOR OFFICE USE: ------------------ --------- ------------- ------ �--_.---_--_._-_r_ -c.°_,) ; APPLICATION FOR SANITATION PERMIT Permit No. _.-.1• ._ ..�--__ �Q �- r >�a ;�'� '� •�^"" {Complete in Duplicate) (v - - -; Date issued -3 .------------------------ 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. r / . 1 +.. JOB ADDRESS AND LOCATION___ _��c tiT� 7 �•[_/ - -3 -'-=--------------- - ---------- -�714�1 Owner's Name `✓� -- ------ ------- ----- ' - , Phone a r Address. , _ / --c-st - - ----------------------------------•--------•------•--------- Contractor's Name �� --- --- —�--------•--------'---- Phone----------------------------------- - will serve: ' Residencex Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livin units: -- -_-_ Number of bedrooms ---- Number of baths / Lot size ----- -------------------- f Water Supply: Public system ❑ Community system ❑ Private [K Depth to Water Table.?--!e ft. F Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay [❑ Adobe[] Hardpan ❑ Previous Application Made. (If yes,date---- --------------) No a New Construction: Yes ❑ No.& FHA/VA: Yes ❑ No X TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted cif public sewer is available within 200 feet.) 11: Septic Tank: Distance from nearest well----- from foundation-----/Q---------Material - ----- --------------------------------------- ----- --------------- ..----.-. No. of compartments--------1...".2„--..__._Size-___... Liquid depth------ r__'____------Capacity----- --- -_ Disposal Field: Distance from nearest well`._,,v--e_-.--Distance from foundation----- --------Distance to nearest lot line------�_.... [X� Number of lines-------------------. Length of each line------ ----------.Width of french----------�---------- Type of filter material...._-Depth'of�filter material___---�tF-�-..Total length---------------�-s�--�____-_--- Seepage Pit: Distance to nearest well----- ---------------Distance from foun`detion4_-------_--- -----.Distance to nearest lot line------'.------.-- Number of its------t-.--- '------;Linin material----------------{_ ----_Sizelbiameter------------------ �. I rp Cesspool: Distance from nearest well-=---------------Distance from foundation.- -------- --- Lining material=_--------------.._.----------------- t ❑ Size: Diameter.....*;-------�--'4........... Depth- ---------------k----------------------------------Liquid Capacity-.------=-------------------gals. Privy: Distance from nearest well ----------------------.-------.---------_-..Distance from nearest bu;lding------------------------------------------ ❑ Distance to nearest lot line---��----- ---------------------- ------=---------------------------- Remodeling and/or repairing (describe):----- ?-z-- --------------- --- --------- ------- --- --------- ---------------- -------------- _- r ,: .z . r 21 I h4eby cert y that I have prepared this ap icat'ron and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r ulationsiof.the San Joaquin Local Health District. (Signed)--- - ----- - - ------------------------------------------------' Owner and/or Contractor)—' • t a BY: ' ------------------------------------:---(Title)-------------- -------------------------------------------- ---------- (Plot plan, showing size of lot, location of system in relation.to wells, buildings, etc., can be placed on reverse side). FORD RTMENT USE ONLY , APPLICATION ACCEPTED BY----- ---- - ----- -- ---- DATE © 1 6 REVIEWEDBY------------------------•= •---- ------------------------- -------------------------------------------------------------- DATE----------------------------- BUILDING PERMIT ISSUED- I--••-----------------------------------------------------•--------------------------------------- DATE Alterati ns nd r recommendat ------_ � � ------ - ------------ f - . - . 3 J. -- - ------------ ---- f ----------:---- ---- ---------- ------- ------ -- --- - y = ----- ------- ------------------- ------------ ----------------- -- --Za/3 �< ------ .-- -- - FINAL INSPECTION BY:. ---------------- ------------- Date--------------------- - ------ --- - ----- t I L 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 ES 9 REVISED 5-59 3M 3-'63 F.P.DD.