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FO OFFICE USE: {---------------- - - �--- f APPLICATION FOR SANITATION PERMIT Permit No. �. r . � --------------------------------------------------------- (Complete in Duplicate} !/ -- ------------------ This Permit Expires 1 Year From Date Issued Date Issued -��/..----- --__G j 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, JOB ADDRESS AND LOCATION-<_.I,$�79--- ---- --------------- f Owner's Name---- �.�`" ------------- •--•----------------- -- ----- ------ Phone--------------------................ Address---------------->35.. . Contracaor's Name - ""---12----------------------------------------------------------------------------------------"--- •-•------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [❑ Mote! ❑ Other ❑ Number of living units: ----�"_ Number of bedrooms _Z- Number of baths _1--- Lot size _" "t _. x-- 0 r --- Water Supply: Public system Community system ❑ Private E] 'Depth to Water Table -.4_ -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--------------------) No [ New Construction: Yes LS leo ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 1%, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �] F r Septici�: Distance from nearest well----'l`__--Distance from foundation---- -------------.Materiai--.-_-------- --- ________" � No. of compartments------2---------------_Size----" "- _� _�-_"_Liquid depth-Y. __....."""___--"Capacity_____,7Gr"- _ Disposw -Field: Distance from nearest well--'--Distance from foundation-_la---_-------Distance to nearest lot line-5-0 ... Number of lines""""_,, "-""-"--.-- "_Length of each line-7b"��-U_-----------Width of trench-"-".2¢__ -`______________ _ Type of filter ._-Depth of filter material/k"`._-_-_ .Total length_--.9Q_.-__-_--"-------__.."-.------- , r Seepage it: Distance to nearest/well---" .--.----Distanc from foundation" IP.........Distance to nearest lot line -J�"."""-"- [LY Number of pits-.-."1"-""-__-"-""""Lining material- OSize: Diameter.__.r�3_______---Depth--_- �------.- ------ Cesspool: Distance from nearest weft-----------------Distance from foundation___------.----------Lining material----_------_--____-_------------ ❑ Size: Diameter--------------------------- ----------Depth--------------------------------------------------.-Liquid Capacity----------------------r-----gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building----_----_-----------------_-____--.-_.-. ❑ Distance to nearest lot line = - Remodelingand/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------•-- ------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- 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, and 4andtions of the San Joa uin a[ Health District. St ned( .g )----------------------- -- -- - - --1�``�--�--A-------- ------------------- -- (C�t�e�andrLcr Contractor) --•-- -•--B'Y°-------•- =- ----------------------- - ----------------------------------- -- •----(Title(Plot plan, showing size of lotem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY cid ---------- ----- ------------- DATE--------- REVIEWEDBY----------------------------------- ------------------------- -- ----- ---- -------------------------------------------------- DATE------------ BUILDING PERMIT ISSUED------------------------ -" d _ ------ DATE- ATE- -- ___7�0/.— ___- -_Alterations and/or recommendato __ _ -_ ------------------ ---••---•---•-- ----------------- ----- ---------------------------------------------------------------------------------------------------------------------------------- ------------- --------------------------------------- •------------ ----------------------------------------------------------------------------•-------------- ••------------------------------------------------ ----------------- -- ---------------------- -----------------------------•--------------------------------- ------------------------------------------- ------------•------------------- FINAL INSPECTION BY:-_ '_ Date6 T Q --- ----------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E6 9 REVISED 8-59 3M 3-'S3 r'.p.CO.