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r•ux VI-l-ICt USE: -- 6 - . ------------- ----------------- APPLICATION FOR SANITATION PERMIT Permit No. - .7.,-�5 -------- ---- -. � � (Complete in Duplicate) ------------------ -------- ---- This Permit Expires 1 Year From Date Issued Date Issued 9_z_�-_�• 3 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________ haw / L Owner's'Name- f - _.t - 17a1►�1�//�� <:, Phone-14--------------------- Contractor's --- - �/. Address-_.---��---- --• ------------------------------------------ - -- -------------- ' Contractor's Name----__ �V_�/ ,- � ----- " -------------------------- Phone- 4P_6_—__ Installation will serve: 'Residence Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --_-_--- Number of bedrooms ,_3---- Number of baths -2--- Lot size -__ Water Supply: Public-system ❑ Community system ❑ Private QJ Depth to Water Table 9,Soft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay W AdobeX Hardpan ❑ >. Previous Application Made: (If yes date--------------_----) .No ❑ New Construction: Yes U No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tankor cesspool permitted if public sewer is available within 200 feet.) I , .� Septic Tank: Distance from nearest well--_�d...-Distance from foundation- I -----------Material---_---__----------------------- ,� No. of compartments-_- ---- p - 2.-----------Size__.1.�_!> Q q�C��-Liquid depth-- --- -.P r� Disposal Field: Distance {rom nearest well_. '_ _ ` 4.`Z-, Capacity___/o V .Q-___.-.Distance from foundation__-�_Q_--- -_.Distance to nearest lot line---- Number of lines A___171 _ - ------.--Length of each liine-_*?-d_�4_4>�7_--._'_Width of trench--------_--..� ! Type of filter materiaL._ Q_�} __ ---Depth of filter material---[_ __________ __Total length--------1_Q- -:__-------_-____-----_ I Seepage Pit: Distance to nearest well-.f -- - s�------Distance from foundation-_--- d_______.Distance to nearest let fine-_s.�_.-____ Q fl / 0 Number of pits----_---f-----------Lining material----/?A.G�K._---Size: Diameter_' -. -- t-Depth-� -- _____-- s Cesspool: Distance from nearest weft-______.._----.-Distance from foundation__._---------------Lining material---___--__----.__---_-.------ --.-_. ------- ,X, / &.0�� ❑ Size. Diameter--------------------------------- ----Depth------------- - q 9 gals. Priv Capacity Distance from nearest well__-------------------- �11 Liquid Ca aci -------------------------Distance from nearest buildin ❑ Distance to nearest lot line- ----------------------------- ----- s - --------------------------------------- Remodeling and/or repairing (descrikbe)---------------------- ,r 1 ------------------------ ---------•------- ---- a le---------------------------" '----- -------- ----------- -----------------------------i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joauin Counf ordinances, State laws, and rules aannd7 regulations of the San Joaquin Local Health District, q y (Signed)-----OV1��-0_AC Lr OJI/�' �' --. ,fesV. , �. -------(Owner and/or Contractor) 0 - ---------•----•--- (Title) (Pio} plan, showing size t, location of system in relation to wells, buildings, efc., can be placed o reverse side). t FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•- - DATES REVIEWED BY ----------- ---- - DATE_ BUILDING PERMIT ISSUED-------------------- --' --------------------------------- - --- D Alterations and/or racommen ations:__ -_ -- ------ --------------------- A--T---E --- -------:- /5`0 ` - D.` � -- --- ----- -- .-_ .� ...... -- ---- --f---- ----- ----- - ------------- �. s----- -- ---------- ------------ -- FINAL INSPECTION BY:-------- .. ,G, --------------------------------- _ Date--. , ------ ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 1:.Hazellon 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 i.P.Ca. .