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OR� FIC SE: ---�---- -� APPLICATION FOR SANITATION PERMIT Permit No. - -- --- ----- -------= - ------------------ ------------------------------ -----::' (Complete.in Duplicate) r --__'._- This Permit Expires I Year From Date Issued Date Issued . __- - :�':_.. Application is hereby made to the San4Joaquin 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 AND LOCATION--------- ---- _ -------------------------------------------------------•--••------ �r Owner's Name---•----- Phon .`3 Address------..Z�l---_-- ------ .......... �,. ... " =- q Contractor`s Name -6r------.d �"`r*�` Phone64 �/ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:IV_____ Number of bedrooms _"/`/ Number of baths .Sd o---®4----------------------- Lot size .� ---- - - i - Watei• Supply: Public system,''❑ Community system ❑ Private)[ Depth to Water Table V 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 [INew Construction: Yes No E] FHA/VA: Yes ❑ No E] TYPE;OF INSTALLATION AND SPECIFICATIONS: r (No septic tank'or cesspool pertitted'if public-sewer-is available within 200 feet.)�-t „ I 't Septic Tank: Distance from nearest well_SQ_--____Distance from foundation__-1}----___.Material_- 11% �r i No. of compartments___t�________________Size_��!-�S�/?-_____Liqu,id*depth-__�.��__-___--Capauty__a -_Disposal Field: Distance from nearest well_Sd_-_-__-._Distance from foundation__ _ 4_ ;--__Distance to nearest lot line_______________T eof fil lines___y_p -_-____. Length of each line_ d_____/d_.��_ ___-_Width of trench___.. - -____________Number ofter material__-c_ _�_ ' - ____Depth of filter materiaL__�_R____--___-.Total length_- _--_I- ________________Yp , � ,� iF Number oo nearest well ______ _______Distant om f undation-ance ,� _________-Distance to nearest lot lineSee e Pit: Numbdr tf pits__- ;,t____- ---Lining material_ _Q'��r----Size: Diameter_--3-3-_ _-_--.__Depth_-_-_-_�-�_______-____..Cesspool: Distanece from nearest well------- ---------Distance from foundation- -________-----__.Lining material_-_--_-_--___-----_-___________-Size: Diameter. #-------------------------------Depth--------- __Liquid-Capacity------------------------=---gal,Privy: Distance from nearest well_________________________________________________Distance from nearest building___--_-__-____________-_--.-__---____-_ ❑ Distance to nearest lot line-------- ------------------- Remodeling and/or re'pai ring�j(descriUe):---________________________ --_ - - ------ 1 IL € &, =-------------------------------••------ - -------------------------------------------- ------------ --------•--------------•------------------••-•---------------•----------- ---------------- hereb , tf that I ha ------------------------------- -------------- --------------------------------------••----- --------------------------------------- ------------------------------------------------ --------------- ti3 py r y I "ve prepared this application and that the work will be done in accordance with San Joaquin County .,ordinances, at laws, an r"les ander gulations of the San Joaquin Local Health'District, i (Signed) i- f----- --------- - ----- Owner and/or Contractor) " Y= / ------------------ ( 1 ------- ----------------- . _ . .... ---I-----• -------------�- ---- -----�-- Title �i (Plot plan, showingsize of'lot;location of system.in relati to wells, buildin s, etc.,_can be placed on reverse side]. F R DEPA TMENT USE ONLY 4 APPLICATIONACCE. -------- - ----- --- _------------------------------------ DATE- ---------------- REVIEWED BY- 9 �� f DATE---------- -------- -- BUILDING PERMIT ISSUED---Ii --- ------- -- DATE = - - - Alterations and/or recommendations:__._ ---- r- -- j ' . --------�----------•------------------------------------- P ---------------------------------------------------------------- ----------- ------------------------ - ---------- ---------- --------------- ----------------------------- ........ ---- ------ ---- --------------------- ---------- ------------ -- ------------••--------------------- -- ------------------------------ ------------------------ s-- ------------------------------- ------ ---------• -------- - ------------- ------- - FINAL INSP Y:. -•-- - --- ---- --- Date- --- , ----------------------------------- SAN JO UIN LOC HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F =; E5 9 REVISED 8-59 3M'3-'63 r.p.ou .wr _