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FOR OFFICE USE: ------------------I'm------ ....9 -/000-6..__---___-_---___------ --- AP LCATION FOR SANITATION PERMIT Permit No. ----- -------------------------------------------- (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 construct and install the work herein described. This applicatipri is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION --------- ....... --------- -- ------------------------ -------------------------------------------------- Owner's Name------i?-d11110v_-W .0fe-------A71.o e-------------------------------------------------------------------------------- Phone-- ... ..... ........... Address------------_-- -,q ------------------------------------------------------------------------------------------------------------------------------------------------------- Name----- Phone. Installation will serve: Residence [] Apartment House El Commercial El Trailer ��l 0 Other [I Contractor's Na -------owoe ...----------------------------------------------------------------------------------------- Number of living units: .-_f--- Number of bedrooms Number of baths ---/__ Lot size Water Supply: Public system El Community system [I Private 0?'**Depth to Water Table . ft. Character of soil to a depth of 3 feet: Sand E] Gravel F ] Sandy Loam [] Clay Loam F Clay 0 Adobe[B-lHardpan 0 Previous Application Made: (If yes,date____________________) No �ew Construction: Yes P-<. E] FHA/VA: Yes F-1 No Er-' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic,,Yank: Distance from nearest well__,5;�--------Distant from foundation---/ -------...Materia ----------------------- No. of compartments----------'2- -----Size.......... --------------------Liquid depth-----!��-----------Capacity.-- C11 Disposal Field: Distance from nearest well-- -------Distance from foundation----/0-- ---Distance to nearest lot line..... Number of lines----------------:T ..__.-..----Length of each line-----------—---------------Width of trench-----------2---J, ---------------- Type of filter mate ria I_,1e0-_eA(,---------Depth of filter material-....f f.//-------Total length--------/9_d _-------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------..Distance to nearest lot line.-..-----------_ F-1 Number of pits----------------------Lining material-----------------------Size: Diameter-----.-.----.----.----.Depth--------------------------------- Cesspool: �A esspool: Distance from nearest well-----------------Distance from foundation___........____...Lining Lining material------------------------------------- El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well.................................................Distance from nearest building.----------------------------------------- IDDistance to nearest lot line-------------------------------------------------------------------------• ---------------------------------------------------------------- _&W--- --- Remodeling and/or repairing (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 laws, and rules and regulations of the San Joaquin Local Health District. ---------- ----------712-- ---------------------------------------------------------- -------(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 I-ey,110 ------_------------- -------- ------------------------ APPLICATION ACCEPTED BY----------- ------------ ------------------------------------ DATE REVIEWEDBY--------------------------------------------- ------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alteratigns and/or recomm dations:- --------- .................. -•--- ---------------------- a - -- -------- - - ----------�N -------------------- ------------------ ------ ----------- ----------- -; ------------- ----------- ...... .. . . .......------------------------- ... ...J, --- ------- ---- ------ --- -- . ........ ------------------ -- ---------- ..... ..... ----�?A_ ..... ... -- - -0-------------- ------ ------- FINALINSPECTION Y%....----- -------------------------------------------- Da ------- /;7----------------- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT VW E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 95 9 REVISED B.59 3M 3`63 F.F.C13.