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FOR OFFIMUSE: ... . ----------------------- ;----------------------- . --------------------------------_-------- _-__ --------- APPLICATION FOR SANITATION PERMIT Permit No:,:.��... --------------------------- ------------ -------- (Complete in Duplicate) Date Issued fl ___.--_.- 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 JOB ADDRESS AND LOCATION W.�f _ �_.� __ , ,(�,,�.� - a - - - --- Owner's Name- _`_& e�-------- -•----------------•----------- - - ----- Phone----•.k ------:_--------•---•---- �l �'"r Address - Z- !fit- " •--- l `•• - -----; Contractor's Name---------- -----eV ------ ,. 4--------- 4-.....-------•----.... Phone----/' Installation will serve: Residence Id Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 'Other 4 E] I OV ` Number of living units: ----�-- Number of bedrooms _- Number of baths __7�Lot size __-------_ _ ----------------- # �/ - Water Supply: Publiclsystem Community system E] Private u Depth to Water Table -------- ft. ` _j Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam M( Clay Loam ❑ Clay n Adobe Hardpan ❑ y Previous Application Made: (If yes,date------_-------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA:IYes ❑ No E]TYPE OF INSTALLATION AND SPECIFICATIONS: # �;! (No septic tank or cesspool permitted if public sewer is available within 200 feet:) ��yy "� # Septic ank: Distance from-nearest well_�E2__�__-Distance from foundati ----/4)---Materia4---------riS.�_- _-- - No. of compartments--.��-------------Size- -�__-_-��'_�-j( _Liquid depth__-_-�-�.---.._--,CapautY.. _- -. Dis o Field: Distance from nearest well._,�D __Distance from foundation-----la-` _---.Distance to nearest lot line- � Number of lines........... Length of each line./49_7_7& ZD_.' Vidtn of trench--- ------------------------- Type of filter material-- _ _______Depth of filter material------f 4---..----_Total length-----4_51G------------------ .___-- O Seepage Pit: Distance to nearest well-------------------_-Distance from foundation...................Distance to nearest lot line---------------.- ❑ Number of pits----------------------Lining material---------- -----Size: Diameter------------------------Depth- I. Cesspool: Distance from nearest well-----------------Distance from foundation_------------ --._,Lining material -._-__--------------_----------.-._ ❑ Size: Diameter---L-- --------- ---------------------Depth---------------------------------------------------Liquid Capacity- - --------------------------gals. Privy: -_ Distance from.nearest well-------------------------------------------------Distance from nearest building__------------------_-------- _------- '> ❑ Distance to nearest lot line--------------------------------- - -------- ---------------------------- - ------------------- Remodeling and/or repairing (describe)---- --= ----------- -------------- ---------•------------------------------------------------------------------------------------------------------ -- -------------------------------------------------------------=------------------------------------------------- -------------------------------------------------------------------------------------------------------------- r i -fid f e I hereby certify-that I have prepared this application and that the work will be done in itccordance with San Joaquin County ordinances4Sfate s, andrules and regulations of the San Joaquin Locai-,Health District. (Signed) - ------------------------------ ontracfi ) ------- By:. -; '- (Title) -------- -- s r t f F rj.. r (Plot plan, showing size of lot, location of syst 'm In relatro to wells, buildings, etc., ;can be,pla'ced on reverse side). } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - 41--------- ---------------------------------------------------------- DATE---/1-_/-a�;--__4_y" r REVIEWED BY------- --------------------------- ----- ---------------I——----------- ------------- =-------------------------- DATE---,'` 't 1 BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------- ------------ DATE i k Alterations and/or recommendations:---------- ----------------------------- -------••----------------------------------------------'------------------------ i ------------------------------------------------- ;-- - ---- --------- 1' #-h -- f . ---- - - ------------------------------------------- -------------- ---------------- --------------------------------------- ------------------- --- i Date - ----------- w FINAL INSPECTION BY n SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California ; Manteca,California Tracy,California re 9 REVISED 8-59 3M 3-163 F.P.120. '