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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ___lC�.ZS - -- ----------- -------I--- (Complete in Duplicate) > 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 construc4nd install the work herein described. This application is made in compliance with County Ordinance No. 549. -r 17W r JO ADDRESS AND ------ � -----_- ----T Owner's Name-------- ---- -------------- OSI�f f "C3 Phone------ -------------•--------------- Address -...e °'+"-'s -------- ------------------------------------- /� Contractor's Name_ �-'�4�1.,��=x 11e-- _. P ----------------------------------- Installation ----------•-------------------•"-Installation will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms .-4- Number of baths _ ___ Lot size ___ t------- -_._.•__--________________.___-_ Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table SO ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----__-___.._--._._) No [ J New Construction: Yes Z No ❑ 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_-.rb Distance from foundation_.. d Material_ ------------------------ cj7 Rp No, of compartments---,-..--_------ ------- ---Liquid depth-----�----------------Capacity.-?&-T--------- `n J. 61 Disposal Field: Distance from neares welL •_S_0_..__.._Distance from foundation___-1.p______.._-Distance to nearest lot line---s��____-.... � Number of lines----- ---- ----- ------------ -,Length of each line--- _----ka--------------Width of trench.__ -"_-----------------_# Type of filter materi p g �F - _ --Depth of filter material----/- ------------To+al length ----------------------•` w r#: Distance to Piearest we ___Distance from aunda#ion____A0-----------Distance to nearest lot line___ --------- De Number of pits.--- ---------------Lining material--- _______.Size: Diameter._.-� -'r --tP--. pth- Ar-- ------- ------- Cesspool: Distance from nearest well________________Distance from foundation_"----------------- Lining material-------------------------------------- El Size: Dismoter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. PrivyDistance Trom nearest well-------------------------------------------------- Distance from nearest building ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------- ---------------- ----------------------- Remodeling and/or repairing (describe)---------------------------------------------------------------------------------------------------------------------------------------------------------Z4 17 ---------------•---------------------------------••--------------------------------------I------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------- °° ------------------------------------------------------------------------------------------------------------------------------------------------------------------ lope 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S+a laws, and rules"and A gulations of the Sa aquin ai Health District. r (Signed).-- - --- - ----•--=- -------- -- - -- - ---------------------------- - -{Owner and/or Contractor) BY: --------------- --------•------- - -- --- ----- ------------------------------------------------------------------------------(Title) _ (Plot plan, sho ing size of lot, tion of system in relation to wells, buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY p APPLICATION ACCEPTED BY- ------ DATE--f-- ' ------- ---- -- - REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE---•------------------------•------------------------------ BUILDINGPERMIT ISSUED-------------------------------------- -------------------------------------------------------------- DATEI----------------------------------------------------------- Alterations and/or recommendations:------ -------------------------•----------------------------------------------------------------------------•----------------------------- -"-------------------------------------------•-----------•-----------------------------------------------------------------------------------------•--••--•.---•------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ - -----------------=---------------------------�N---------------•------------------------------------------------------------------•--•-------•-------------------------------------------------------- FINAL INSPECTION BY--- - - - ----- ----- -- , Date_-f --- A_ fi -------.-- - ,r --------- /� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hassllon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3m 3-63 F.P.Co.