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l-UX Ul-l-U Ust: - --------- ---------- --- ---- --- ----------- APPLICATION POR 'SANITATION PERMIT Permit No. _ x 1 --------------------------------------------------------- •_ . ------------------------------------------------------ -- (Complete in Duplicate) r - -' _. Date Issued ------1-/---- -�5 __________________________________________________________ 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. f I JOB ADDRESS A LOCATION__ / 7 '___- Owner's Name------- --- i �-�C��r ----- --- -- _.. -------- Phone-----•------------- ,, Address---- --------------�-�...___ = fix. P.... .�� -- •- -----•-------------•------•-•-----•-•----------------•-----•- Contractor's Name.--- L� -rt/J�P„-� -----------------------•----•----•-----------------------'-------------•------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other p Number of living units: __1___ Number of bedrooms __3. Number of baths Lot size __. _rQ45 �_ ............_................. Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table _ `_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam'] Clay ❑ Adobe❑ Hardpan p ' 4 Previous Application Made: (If yes,date--------------------) No Vk New Construction: Yes) No ❑ FHA' /VA: Yes ❑ :?No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well_,,5� --__Distan e from found tion-----1_2,-------Mat rir I ___ v_____________ No. of compartments____ -----.__.____Size__--_X_9,�(____�__Liquid depth______�_.�•�-.�---:Capacity.._�.�0_0_ Disp sal Field: Distance from Weare;twell--- ._Distance from foundation--A.6�_-_-_._.Distance to nearest lot Ii e_-�'--_.---__ {� Number of lines______tf"_____ _____________ .___Length of each line%-�0_- a-_-Z�idth of trench..___ .�_ _. ______-__.__J f Type of filter material._1-��.___Depth of filter material----- *------ otallength----- - __---_____________�,__ _,� Seepage Pit: Distance to nearest well___-------------------Distance from foundation--------------------Distance to nearest lot line--.-------____-__ Gni ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Dept h-.----.-------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------____________._____________.___. ❑ Size: Diameter--------------------------------------Depth--------------------------------- ----------------Liquid Capacity----------------------------gals. _ .. =� Privy:" Distance from nearest well______________________________ ____________._Distance from nearest building___-----__-______________________.._..__. ❑ Distance to nearest lot line---------------'---------------------------------------------------------=------------------------------------------------------------------ Remodeling and/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 rules and regulations of the San Joaquin Local Health District. { (Signed) ��_____ _._ �"'�_ --------Owner and/or Contractor B ' - - i� M taw'- �- -L _-- - -.1-------------- -----------------------------------------Title (Plot plan, showing size of lot, location of l st im in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r' APPLICATIONACCEPTED BY--------- --------- ---------------------------------------------------------------------------- DATE-------------------------------------------------- BY--------------------- --- ---------------------- DATE------------------- - ----------------------------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------- ------------------------- Alterations and/or recommendations:----------------------------------------------- -------------------------------------------------•-----•--•--------------- ------------------------------------ -----•-----•---------------------------------------------------- --------- - ------ ----------------------------------------------------------------------------•------------------•--------------------- - ---------------- ----------------------------------------------------------------- ---- --- ----------------------•-••--•-------- -------------------•-•-----------•--------------------------------------------------;--------- FINAL INSPECTION BY:------ - -�`a--------------- Date---------_/_�------1 7- 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Matelfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stoskton,California Lodi,California 3 Manteca,California Tracy,California ES 9 REVISED 13-59 3M 3-'63 F.P.CD. -+"-'