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FR OFFICE USE: --- ------- --------- APPLICATION FOR SANITATION PERMIT Permit No. - ----------------------- ----------------- ------------- �0\1 (Complete in Duplicate) 31--------------------- This Permit Expires 1 Year From Date Issued 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 with County Ordinance No. 549. . , I - W - JOB ADDRESS AND �OJATIONq?�*_# -------4&U. 4-1._464-4.2------ Owner's Name----------- Phone.................................... ---------------------------------------------------------------------------------------- Address........................ Contractor's Name..--- ---at------------------------------------------------------------------------------------------ Phone.................... Installation will serve: Residence ®/'Apartment House E] Commercial E] Trailer Court C] Motel [] Other ❑ Number of living units: Number of bedrooms _X__ Number of baths _/-__ Lot size 7-------------------- Water Supply: Public system ❑ Community system El Private rDepth to Water Table Character of soil to a depth of 3 feet: Sand 0 Gravel Ej Sandy Loam E3 Clay Loam 0 Clay 0 Adobe U"Hardpan ❑ Previous Application Made: (If yes,date--------------------) No PR--"New Construction: Yes [j�' No E] FHA/VA: Yes Jg---No E] 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..N.; e_ _ Distanqg fwm f un(jgtion....../ ------.M gjte;,a T I JAIV-------------------------------------- No. of compartmenfs-.--.4----------------Size_ .. ....X_69----Liquid depth---j - -------------Capacity_150�7e2---- Disposal Field: Distance from nearest well"___.-_Distance from founclato* )n./.��K_ .....Distance to nearest lot line--4r.- _y 00 --------------- Number of lines---/----------- Length of each line---' Width of trench -_________._.__._.__.___...._ .... 9�� -10 �Pwv------- C .0-----I----- --------------- Type of filter ma *eDepth of filter material____,e_/,6-----•------Total leng 15�e--------------------------- terial-/4 Z04 th-_ - __ -_ 10 Seepage Pit: Distance to nearest -Distance Ffrip fwndation---&-------...Distance to nearest Ot line---44---------- Number of pits------/-------------Lining mate ...Size: Diameter_ , __.------Depth ------- Cesspool: Distance from nearest well-----------------Distance from.f.oundation----.----------------Lining material__-_...----_-_.-____-__-_________-_. 171 Size: Diameter___ .. __________________--------------------- ----------Depth-----------------------------------------------------Liquid Capacity------------- ------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building-------- -------------------------- 171 Distance to nearest lot line--.------------------------ --------- - ----------------------------------------------------------------------------- Remodeling and/or repairing (describe): ---------- W-------- ----------............................................. .V ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------.........._------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, and rules and reg:iullaflons of the San Joaquin Local Health District. (Signed)---------------- --------- - - -- -- --- - ------ - ------ Contractor) #A Ar BY:......................................................------------- ----------------------- ------------ ---------- ---------------------------------------------- (Plot plan, showing size of lot, location of syste relation to Wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -—---------------------------------------------------_--- DATE---- ---------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------- --------------- ---------------------------------------------------- DATE-------------------------------------------------_---------- Alterations and/or recoramondations:--------- ---- -- ------------------ ......................................... ..........................................C-------------------------- ................ ------------------------------ =�------- -----rle..................................................------------------------------------ ---- ---------------.- -----_---------- ---- ---------------- -------------------- ---------------------.---------------- ----------------------------------------------------------- ---------------------------------------- ......... --------_-------------- FINAL INSPECTION BY:......elll��-------------------------------------- Date------------'---------2-3-74;01;-------------- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601' ,Hax*lton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th 'Street 110 n,California Lodi,California Manteca,California Tracy,California cs 9 RrLvisEb a-sq 3M 3-,63 F.F.00.