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OR OFFICE USE: f/ 1 9 -------" /_ J_,' PPLICATION FOR SANITATION PERMIT Permit No. .1...�!_ • ----------- --- ------------ ----------- - --------- ------ ------------------- ---- (Complete in Duplicate)_ lDate Issued ___-- ---x�g,Iq .............. 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 here'edebed. This application is made,in-compliance with County Ordinance No. 549. A JOB AD KESS AND L C TION.-./!i/ -- 4'_4�/7 -----4!� --- ------------------- Phone--------------------•----•-----•---- Vr Owner's Name---- -- - �1_Ly:�Cr: f- ------------------------------------------------- ------------- - ".. � ------AO-01 -----------------•----------------- --- � � = --------------- ------•------------------------ Phone---•--•---_----•----•-------------- Contractors Name--------" - - �� ------------------------------------- -•- Installation will serve: Residence °Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Z-__ Number of bedrooms _?_- Number of baths _ "_ Lot size ------------------------------- Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table �7.1 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ClayAdobeardpan ❑ Previous Application Made: {If yes,date------------------- -) No t" New Construction: Yes 2�—No ❑ FHA/VA: Yes j9—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 Distance from foundation__ ---- �l No. of compartments---, ---------- ----Size, depth---' --------------Capacity Disposal Field: Distance from nearest well.410 ----Distance from foundation.-Z-O------- 41 Distance to nearest lot Number of lines------.r1---- j,--- -----._-_Length of each kne_,,o f -----------Width of trench..A,______�------------------- Type of filter 'Material. Depth of filter mate rial__,l ---------Total length__ _______"__.______-_______I ' Seepage Pit: Distance to nearest well__ __ _ - /_ Distance f fo dation__, "__..Dista ce to nearesf lot line ��_.____I /-® 7. Number of its_- Lining material- _49- Cesspool: Diameter_ _.---------Depth ..__-""_""--.------.--•p P �-------- -- Cesspool• Distance from nearest well----------------- from foundation__._-______________Lining material------------------------------------- F-1 Size: Diameter---------------------------- ---------Depth----------------------------------------------------Liquid Capacity------------------------- -gals. 0 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-- .-._._________-_.--------------------- ❑ Distance to nearest lot line-- ------------------------ - -- ---------------------------------------------------------------- Remodeling and/or repairing (describe) .!'1' - S�---- 9__ _ -------------------------------------------------- --- ----------------------------- ----------------------- - ----------------------------------------— - — ------- -------------- ------- ---------- -- ----- — --- -- --- ---- - --------- a 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, andrulesand regulations of the San Joaquin Local Health District. 1__� 5i !- ' "� ! -- -------- ------ ( �or Contractor) (Signed) ---g gY= ----� ------- (Plot plan, showing size of lot, location of system in r tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONL APPLICATION ACCEPTED BY - -- --- ------------LDATE r - --- ---------------- ------ ------- ---- G REVIEWED BY -- --• ............ ---- ---- DATE-------------------------- BUILDING PERMIT ISSUED-------•------ -------------------3- - - ----- DATE.. Alterations and/or recommendations:-----f S- �-- --------'�--- ------------"--- g ------------------------------------------------.--------.--------------.___________.__- -__ - I._ ---------------- f FINAL INSPECTION BY:. _ -- ------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT I 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 9-59 3M 3-'63 F-F-CD.