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FOR OFFICE USE. ry APPLICATION FOR SANITATION PERMIT Permit No. __A.1-4 - --- --- -- ---------------------- ------ (Complete in Duplicate) Date Issued _________________________ This Permit Ex fres 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. - t-73 ~ .�S�3 s • Y. JOB ADDRESS AND LOCATION---�T 4--------- 6a (------ �---------------- � OFFVK-h i N Owner's Name------ --------------------------------------------------- ------ ----------------- -------------- Phone---(.4.0--�a--8 12�i . �. ------------I-A.....................................------------:5 T7 �'(__M�o Address---•----•-••--- - ; � ---- -- - ------q-----------------------r------------•-•--------- Contractor's Name----- ... _,._. "UL.1__�S_�--------t------5©L'--------I--R--LST-------------------------------- Phone..�4_-x_-165-16-o1---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .-I-___ Number of bedrooms _ ,,r Number of baths --- ___ Lot size _____..1__6-------ftr_R__-t- ------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _IVB''- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobe Ej'� Hardpan ❑ Previous Application Made: (If yes,date__- --_- .-----) No>— New Construction: Yes ❑ No 0 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-----------------Distance from foundation___________________Material_.-_------------__-___-------.___------____.____. ❑ No. of compartments---- - ---- - -----------Size--------------------------------Liquid depth------------- ------------Capacity----------------------- y Disposal Field: Distance from nearest well--"- .!;?-'....Distance from foundation...lb.0 _______Distance to nearest lot line_!_QQ_!____ Number of Tines------------I----------------------Length of each line----------j�' .._______.Width of french--------------2-�j�__'�------- � �1 Type of filter material_`� _It______Depth of filter material -_-Total length Ltp.......Distance to nearest lot line_.�_3�_'_ Seepage Pit- Distance #o nearest well_____ __�_�_ Distance from foundation___._ a Number of pits----------i---.-------Lining material_- -lam---Size: Diameter.._.3_3_"_.____.Depth------------- - -0------.-- Cesspool: Distance from nearest well-----------------Distance from foundation----------------------Lining material------------------------------------- F-1 Size: Diameter--------------------------------------Depth------------------------------ - -------------Liquid Capacity-- ------------------ -----gals. Privy: Distance from nearest well____---------------------------------------------Distance from nearest building______..____________________________.____. ❑ Distance to nearest lot line---------------------------- - ----------------------------------------•-------------- ------------------------------------------------------- Remodeling.and/or repairing (describe):-------.a+A___-___�------ ----------- ---------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------------- 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. !>s_- Rrl-- ---- -----_. ---------------------( wner and/,gr Contractor) (Signed)-----------"->� ��QNB # Com. (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-- --- . .t0�------------------------------------------------------------------ DATE---- 1 fa. r�': ----•----------- - REVIEWEDBY--------------------------------------------- ------------------------------- -----•- -------------------------------------- DATE-------------------------------------_-------------------- BUILDINGPERMIT ISSUED----••---------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendatigps:- - ......... ------- -----------------•--------•-•----"---•--------------------------------------- -----------/4- �'� ------ -----------�---------------------- --•----------------------• ---• •-------------------------------------------- ____.____._________________________________________�_____Y_.___ _ .._ __________________________ _______________ _ . .__ ___________ _ ---- --- -- FINAL INSPECTION BY:.---------- .61' ------------- - Date..---. ----------------------------------- ------------------ ---------------- SAN ------------- --- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hosalton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 09 9 REVISED 8-59 3M 3-'S3 F,RCO.