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FOR OFFICE USE: ---------- ----- ____ _ _____ PPLI ATION . FOR—SANITATION PERMIT Permit No. ._,l J (Complete in Duplicate) Date Issued . / Q --------------_______-------------_____-----__ ___________ 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 herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION $z`3 - ---------------------------- Owner's Name- - ----- --------------- -•----- Phone..........-......................... -- Address......... .................... -�!h Contractor's Name----' �: � .��`- ------------------------------------•------------------------------...--------------------------------------------- Phone................................ Installation will serve: Residence [4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: — Number of bedrooms --I--- Number of baths _2 Lot size ___7'��_�F_'_X___f/.�� __ _________________ Water Supply; Public system ❑ Community system ❑ Private Depth to Water Table _ aft. Character of so to a depth of 3 feet: Sand ❑ Gravel ❑ San y Loam ❑ Clay Loam E] Clay ❑ Adobe B Rardpan ❑ Previous Applicatioili,Made: (If yes,date---______-----------) No New Construction: Yes [!Y-'No ❑ FHA/VA: Yes ❑ No [9 - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or�'cesspoo) permitted if public sewer is available within 200 feet.) Ir Septic Tank: farce from nearest w ll_` ®-_:io Distance from foundation__._1_6.________.Maaterial__.� _______ _________ No. of compartments_______________-----------Size__..?_Xs4x_`j_...._,___Liquid depth-----____.......----------Capacity_..00-7-'_0--.__ Disposal Field: Distance from nearest well_ -4__f-_Distance from foundation__94............Distance to nearest lot he__ _____________ Number of lines_._-_��_ __ _________________Length of each line...9.d_____----------------Width of trench___. _ _________:__________ 1 19 Type of filter material_ �°f ......© ________Depth of filter material._•1 -----/_______.Total length___IS'Q__'t________________________ Seepage Pit: Distance to nearest❑.i - Distance.from fo_undation_ f&-----------Distance to nearest lot c line__-------- Number of pits_____ _____________Lining material_._�!1G_/j__.Size: Diameter___ f..-----.Depth_- G ` !----------- ,h Cesspool: Distance from nearest well_________________Distance from foundation----_------_--------Lining material________-___,________________________ ❑ Sizer Diameter--------------------------------------Depth--------------------•-------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well---------------___------------ -------_----------Distance from nearest building.-----_•___-__________-____:______-_____. ❑ Distance to„nearest lot line-------------------------------------------------------------------_---•---•-------------------------•-•------------•--•-- ------ Remodeling and/or rep6iring (describe):---------------------------------------------------------------------------------------------------------•-•-----------------------.............. •-•--- -----------------------------------.......-...----------------------------------------------------...-----_------------------_------_-------------------------------------------...............-.......----------------------- ------------- -•------- •---------------------------•------- -•----------•-----------------------------------------------------------------------................................--•-----•---------•----...................--------- ----------.._.. I hereby certify that I have prepared this application and that the work will be done.in accordance with San Joaquin County ordinances, State I rules apr,regulations of the San Joaquin Local Health District. (Si ned ______ ___ - ------------------J 9 )--- ------------ - ---- ------------- -----------------------------------------------------------------------------------(Owner and/or Contractor) -------- - -- ---- -------- By:•---------- (Title ) - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- _____________________________ DATE------------------------ _______7_? --------- ------------------ - -- --- - ----- - ---------- ----------------- REVIEWEDBY----------------------------------------------------------------- •----•••------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED - DATE ------------ Alteration and or recommefr dations:____.___ /.l-� __�`______1` `.......`._ . Zmac:.. �------- -------- '- : �b C/ 7 ---� z G / . ��e c e-r �, -- ie 'yec---r �E, a �c��_ _ 4e_� W � 9 -------------------------------- - -••-------------- g L FINAL INSPECTION BY:--- ---- . ----'- l Date--- /-% 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 ES 9 REVISED 8-59 3M 3-'63 F.P.CD.