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ClyOFFICE USE - _ ! 0 /- - \i ___ -----------_--------_--------.--------------- APPLICATION FOR SANITATION PERMIT Permit No. ._. ._z-s , * =,T- --------- ., »,M_,. . (Complete in Duplicate) (i y --------------------------------= - --- This Permit Expires 1_Year From Date Issued 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. JOB ADDRESS A�'N�`DDYLOCATION.. ��- Owne'r's Name-__� CN. _____. `-- - -" •------- ------------------------ --------------------------------------------------- Phone---------------------------•-------- Address fi2 ----•-----a---------------- Contractor's Name '` - ��` - -- ------- ----------------------------- Phone--------------------------------- s Installation will serve: Residence ET--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motu ❑ Other ❑ Number of living units: _ ---- Number of bedrooms l-- Number of baths /--- Lot size --------------_.._-__.__-_ Water Supply: Public system ❑ Community system ❑ Private [5--Depth to Water Table _41'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,dateF;.__:_ _.:_-.--__1 No,Za-' New Construction: Yes nNo ❑ FHA/VA: Yes ❑ No F!}J— TYPE.OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted if public sewer is available within 200 feet.) •' i Septic Tank: Distance from nearest weli_ar- 49-__�-.__ Distance from foundation/0-r_-__--__--.Material- ---------------------. No, of compartments ....Size_---_3 x_ q p 'CapacitY___ 0_ _ I P Liquid de th -- Y'-'- Disposal Field: Distance from nearest well.+ ____--_-_.-Distance from foundation. _A______________Distance to nearest lot line-_�1?--._... Ef Number of IInes________ ________________________Length of each-line__1P-__--_------._----._.Width of trench-_a'9 ''------------------- (� Type of filter material o_4-___________Depth of filter material_-/,Y__-----------Total length---4.O__�___________________________ �l Seepage Pit: Distance to nearest well-_/ab------------Distance from foundation-�P.__1........Distance to nearest lot line---� ....... 0_rNumber of pits---J_:--!--------Lining rnaterial._T!__d G�C___._Size: Diameter__..�3 _Depth___—'4 o`-'______________ Cesspool: Distanceji=om nearest well--------------__Distance from foundation-----.---------------Lining material----._____-__-----.-_ ❑ Size: Diameter ------Depth------------------------------------ -------- -----Liquid Capacity- als. Privy: Distance from nearest well-------_________k______________.__.-- ----___._'Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line...------------ Rrepairing .. b --------------------------------------------------------------;----- Remodelin9 and/or re airig ( escribe ----------- ---- ------F------------------- ---------------------------.----•-•------- ----- -•-------------•-•-•------------ ---------------------• cp t T ---------------------- -------------- -------------------- # -------------------------- - ---- -----------I---------- -----------= ------ --------------------•----- I hereby certify that 1 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. } � r l Si ned g } --= -- - ; r --------- ---------------------------------{�sr Contractor) i.. I BY-------- ------`- -- -- ----- ----- ---•---- ------•--------= --------------(Title)------------------------------------------ (Plot plan, showing size of lot, location.of.sysfern in relation to wells, buildings, etc., can be..placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___._�-_,_,_- - -------------- 1 ------------------------------------------------------------------ DATE REVIEWED BY ------ - --- k. ---------------------------------------------------=------------------------------------ DATE------------------ '--------------- BUILDING PERMIT ISSUED-------------------- " i—. . ---- --------------- DATE---------- }------- ------ --- --------------- Alterations and/or recommendations:---�r._-_.b . _ s 1 W }, .1.__ _. __ - ---------------------------------------------------------------------------------------------------------------- _.___.____.______s__---------------------------------------------- --------------- •_------- b 3 � t �-.- INSPECTION BY:.. ,. -------- -------------------- Dates �� ---- FINAL ` SAN JOAQUIN LOCAL HEALTH DISTRICT Y 1601 E.Haxelton Ave. 300 West Oak Street 134 Sycamore Street 205(West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 0 REVISED 5-59 3M 3-'63 F.P.CD.