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FOR OFFICE USE: a� a --------------------------------------------------------- _--..........31............. APPLICATION FOR SANITATION PERMIT Permit No. _. ..1�.. ---------------------------------------------------------- (Complete in Duplicate) �d 7 Date Issued -------------------------------------------------.__. This Permit Ex fres 1 Year From Date Issued _'___________-___ 4 �3-- /'?0—z/ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap Ilcation is made In compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_ --�'lC __, r.l� _ r ---a- ----5'< ----- ( -�� / ---'-------------------------- Owner's Name----1-40__ -------- d• Phone------------------------------------ Address....... _._ ff `---------Qr --- -------------------------------------•-•-----------------------••---------- ----------------- Contractor's Name------- -~ Phone , '� ---------- ----- Installation will serve: Residence ®Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-I-_ Number of bedrooms t9--- Number of baths X__ Lot size _____________________; ~ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 749_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay dobe❑ Hardpan LI=� Previous Application Made: llf yes,date____________________} No R�' New Construction: Yes 9�"No ❑ FHA/VA: Yes [tom+ 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---Aa.`__Distance from foundion__Ze----------Material/�p ______________. No. of compartments__��_-----------------Size_' , f--_ .. -Liquid depth.__14"'�_'----------------Capacityl-119��_____ Disposal Field: Distance from nearest well-.09�9.-----Distance from foundation__,��____-_-.Distance to nearest lot linel;:�f--------- Number of lines___._ - - en th of each line_ � ---------- - 9 ��- - -- - Width of trench--�--11-�;----------------- - Type of filter,material]f Depth of filter material---:L.4---�' -_Total length--.-P�__ _____________________ Seepage Pit: Distance to nearest well._ - --Distance fpm fo dation, _.___. staPp to nearest lot line- NumbeNumber r of pits-..X r______________Lining material____/-� ___n_.Size: Diameter__��_.__.__..____Depth- .v:>�.__+ _____________.__--__i !' Cesspool: Distance from nearest well-----------------Distance from foundation--------.-----------Lining material-----------------------------------`El ' Size: Diameter--------------------------------------Depth---------------------------------- ------------------Liuid Capacity al Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-- ---_. .---------------------------- El __--______________.____-_ _❑ Distance to nearest lot line - -•-----------------•---------------------------------------------------------- -------------- Remodelin and/or repairing describe :---_____ -__ _]_� 547 � �,,, --•----------------••----------------------------------------'----•----------------------------------- ------------------- ------ --------------------------------------------------------- ------------------ -- --- - ----- ------------•-- -----•---------- ------------------------------•------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin CoInjordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 5i ned ------ � -- F= rG� - ------ - --------------------------- ----- �i`or Contra ------------------_--------- ----------------------- --------- -- -- ------- rtle (Plot plan, showing size of lot, location of system in rela o o wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- G`/ DATE---------� ----R A ----------------------------- -- ------------------------ - -----•------------ --------------------------- DATE--------__--------- REVIEWED BY BUILDING PERMIT ISSUED------------------ -------------------- --------- ---------------------------------------------------- DATE------------------------ --------------- ----------- --------- Alterationsand/or recommendations:--------------------------------=------------------------------------------------------------------------------------------•------•----------------- ---------------•--•--------•---------------------------------------------------- ------------------------------- ------- --- _- •-------- -------------------------------------------------- ------------------------------ ---- !/ � d -------- ---------------------------------------------------------- -------------------------------------------------------------------------==-------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------ q FINAL INSPECTION BY:. ---------------- Date.._- `-..~ 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 99 9 REVISED S-S9 3M 3-'63 F.P.CD.