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FOROFFICE USE: ----------------------------------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. _Z.3 SP.r— := (Complete in Duplicate) ------------ -------------:--------- --------------- 'Expires This Permit 1 Year From Date Issued Date Issued Application is hereby made to they San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in corn pl iance_with County Ordinance No. 549. JOB ADDRESS ANDLOCATION-5=f -------------- Z" ^�� F � c e.� t Owner's Name------- .____lam------ .ice h 7t'- -� o. Phone 1 //�� ----- -----------------------i----------- Address-_! _.?1,,0. ----------•---- Contractor's Name ' ___ _._ -------- Phone----------------------------------- f Installation will serve: Residence [[ Apartment House [J Commercial Trailer Court r ❑ ❑ Motel Other ❑ Number of living units:__--f�number of bedrooms --- Number of baths ---- Lot size .-� __ - __ -----1-•_/ Water Supply: Public'.system ❑ Community system ❑ Private-;krDepth,to Water Table._._. ft. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay Loam,❑ Clay E❑ Adobe' Hardpan ❑ Previous Application Made: (If yes,date_________ _) No w Construction: Yes ❑ No 'FHA/VA: Yes [jNo TYPE OF INSTALLATION AND SPECIFICATIONS: 4 ` (No septic tank or cesspool permitted.-if.public sewer.is available within 200 feet.) i �Septic T n g Distance from nearest well............:....Distance from foundation......._ Material---------------- No of campartmnts ____ C --------------------------------- ---- ________--__5 ______-__---.�.__f-. ---- --------------•-------- --- qudepth-------------- ----- - apacity ------------------- Dsposa Field: Distance from nearest well ____.Q__---Distance from foundation---L.?_---...._.Distance to nearest lot line- :. Number of lines!------------ .............. Len Length of each .line__ Af - 9 �--�----- �----Y Width of trench----/- A/ ---Type --------- -------- i / I �Type of filter material.. .. pepth of filter material....... . .......Total length..__--..JG2_�r�-- "Seepage Pit: Distance to nearest well-------------- -------..Distance from foundation....................Distance to nearest lot line......__--------- s1 ❑ Number of pits---------- -------Lining material-------------:--------Size: Diameter-----------------------.Depth----- ------------------------- Cesspool. Distance from nearest well................ Distance from foundation.__-----------------Lining material---------------------------Size: Diameter --- --------Depth-------------------------------- --------------------Liquid Capacity----------------------------gals. __ u .�. _ �. • - - '_ � _ Piiv 1]istance from nearest well- --._.. �' "'" T ?Di`stance from nearest-6uil'ding'�"�--- �--* ❑ Distance to nearest lot Remodeling anq/offrepairing (describe): ��Llr �� w--:r -------------f--------------------------------------------------�' r ----- ---------------------------- ------------------------------------------------------------------- . 9' ----------- F ----- -- -- --- -- - - - - - - - hereby certify hat I have prepared this a ation and that the work will be done in accordance with San Joaquin County ordinances, Stat a s, and rules rid re ons the San Joaquin Local Health District. (Signed)----- ---- ------ - ---------,- ---= ----------------- -------- --- --------------- --------------------------------- - -----(Owner and/or Contractor) By:--------------------------------------------------....------. ----------------- --------------------------------------------(Tif lei---------------------------- ------- --- - ---- ------- -- (Plot plan, showing sixe of-lot, location,of system-in-relation.to:w.ells, buildings, etc.,,can be placed on reverse side). { FOR DEPARTMENT USE ONLY APPLICATIOW ACCEPTED BY----- DATE---- -- ---- _ --------------------------------------------------------------------------------------- - -------------- - ------- ---------------- - ------ -- /� BUILDING PERMIT ISSUED = = 1 ?.`�r��D? E` y r- r ; Alterations and/or recommendations:............ ---------------- ---------------------------------------------------------------------------- i --------- ------------------------•---------------- ••--------- ---------------- ------------------------------------------------------------------------ -- ----- ---------- -------------------- FINAL INSPECTION BY------------------- --- Date / .... ; SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. t 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California [5 9 REVISED B-59 3M 3-'63 F.P.CC. .• y.