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F R OFFICE USE: � : . -------------------- .--- -. APPLICATION FOR SANITATION PERMIT Permit No. . ---7..js --------------------------- _ . -- ---------------- ------------------------ --- (Complete in Duplicate) , t Date Issued This Permit Expires 3 Year From Date Issued l�3—COD_ �3 Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This ap lication is made in compliance with County Ordinance No. 549. "°rCas70+a„ JOB ADDRESS AND LOCATION.�?� d_°9-.IV__4„�'a_----R------Tm-- -tr-x- -_R .__LG�T - --- 1__ n�_ ._r�__,f T� Owner's --------- �--------------------- - -------------------------------------- - Phone- Address------lJ74-7----- r!/p.x-r,► ---------------•-----------------------------------------------------------•-•-----------------•---------.--------------•- Contractor's Name-------------- . . �_. ------------ Phone._'f-1�--- -_t Zr7_& ------ Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. __L___ Number of bedrooms _-Z--_ Number of baths ---L--- Lot size -----------f 7------- -_______________ *,Water Supply: Public system ❑ Community system ❑ Private ®- Depth to Water Table _4r__•{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 Z-- New Construction: Yes ❑ No 0— FHA/VA: Yes ❑ NO ❑ ,TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) w Septic Tank: Distance from nearest well________________Distance from foundation--------------------Material ___._______________--------------------------.-. ❑ No. of compartments--------------------- ----Size------------------- ------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well---- '_�._�__Distance from foundation_-_--!.a_____.___Distance to nearest lot line___/-______ - []- Number of lines_____________I--------------------Length of each line-__.______ai_~Q...........Width of trench--------2!-------------------- r� Type of filter material __±..0s<_k-------Depth of filter material------lsf-----------Total length----------5~0_ _____________________ Seepage Pit: Distance to nearest well _._ Q_4?__A-____Distance from foundation----/?----------Distance to nearest lot line_ __07�. Number of pits--------1-----------Lining material-_---_dgj4 AC--.Size: Diameter--- Depth------ ----------------- 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-----------------------------------------------1------------------------------------------------------------------------------------------- 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, ano rules and regulations of the San Joaquin Local Health District. i (Signed) ------ - ----r----- - ------------- -- -----------------------------------Z--------------------- Owner and/or Contractor) f -- -------------------------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTME T USE ONLY APPLICATION ACCEPTED BY------------ --- -�5 -�-------------------------------- DATE:------ ----------------------- REVIEWEDBY-----.------------------------------- ----------------- --------------------•---------------------------------------------- DATE------------ ------------------------•---------------------- BUILDINGPERMIT ISSUED----- --------------------------------------------------:---------------------------------------------- DATE--------------------------------- Aiteratio s and/or rec Ertmendations:_________________________________ -- / ------ ----- --- ---------- --- - ------ -------------------- ----- -- --------------------------------------------------------------•-----------------------------•----------------------------------------------------------------------------------------------------------------•--- FINAL INSPECTION BY:------ -`-•---------•---------------- Date-----------44_� -f--.---J----•-•-----------------•------- 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 Y E6 4 REVISED 8-59 3M 3-'453 F.P.CC.