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FQR OFFICE USE: 4 `f Permit No. -----• -- _.Z-- ----------------------- - �- - y'_�-1-- APPLICATION FOR SANITATION PERMIT 1 ----------------- --------------------------- ----------- (Complete in Duplicate) y Date Issued ------------_------------- -------------- --------------- 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 withCountyOrdinan e No. 549. JOB ADDRESS AND LOCATION l- / ..`"'-""-"-c.(7 Owner's Name---- -------- --------------------------------- ---... Phone---------------------------•----•--- Address-----•-------------- -- --------------------------------•---..._.-------------------------------------- --------------------- PContractor's Name--------------------------- -------------------------------------------•----•-------- Phone--------------------_-_------ Installation will serve: Residence [A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other tZ Number of living units: -_ L Number of bedrooms -A._ Number of baths -------- Lot size __�--A9—'CetA4-,0------------------------- Water Supply: Public system,g Community system ❑ Private ❑ Depth to Wafer Table y ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeA Hardpan ❑ Previous Application Made: (If yes,date---__---------------) No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__..?--.---_-Distance from foundation__,J_Q....._.Material---F.E'___________________________-____.. No. of compartments-----c ------.---~- Size_ �K. � --�-----_---Liquid depth------�--------------Capacity-----a- IF Disposal Field: Distance from nearest well__ -----Distance from foundation-, _---------Distance to nearest lot line__ •-_________ Number of lines______------.-,,- _ __Length of each line_ _Q__ h4-_._.Width of trench_______.1_�_______--�_-- T e of filter material_ S_ __�TDe Depth of filter material_____ ____ Total length_____________________ a7__tQ_______yr �l Yp p ,��- Seepage Pit: Distance to nearest welL,6,_A__..........Dist anc from °undation____/,a_-.___.Distance�p nearest lot line_____ Number of pits----t�_____________Lining materia/I -- -- - -.___.Size: Diameter$.R__' _�___.Depth-_--._.__A_J_-___________ Cesspool. Distance from nearest well-----------------Distance from foundation--------------.-----Lining material----------------._____.__________. ❑ Sae: Diameter----------------------------- ----..Depth---------------------------------------------------Liquid Capacity-.-------------------------gals . Privy: Distance from nearest well----------------------------------------------.__Distance from nearest building------------__-_________________--.___.._. ❑ Distance to nearest lot line--9------------•------------------------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):---------"-- ----- -- ---- ---- -------------- •---------------------,-------•--- ----- --,--- - ----- ------------- -- - ----------------------- ----------------- -- -- ----------- I ----- -- - ----- - -- -----_ ------ ------- - - -- - --- - --------- - -- ------ - - ----- -------------- --------- --�,��----- l3 Piin'ancees�laj�laws, ertify that I h e prepared this application and that the work will be done in accordance with San Joaquin County oanes and regulations of the San Joaquin.Local Health District. (Signed)_ -_- `-------- ---------- caner and/or Contractor] - ------------------------------(Title)- (Piot plan, showing size of lot, location of system/ r a i o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----GIL/--------- ----------------------------------------- DATE---------- ---------------- REVIEWEDBY------------------------ --------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED_----------------------------------------------------------- ----- -------------------- DATE------- ---------------------------------------------- Alterations and/or recommen ations:_-.�-�'7:< ----- -------[��----------------------------------- 1 �, -.0 -= - - i � c _, ----------------------------- -- --- ------------ --------------------•-------------------------------.------------------------------------------------------------------------------ FINAL INSPECTION BY:--- _ Date--- -- j`/__i'Z 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 E5 9 REVISED B-54 3M 3-'63 P.R.CD. F