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FOR OFFICE USE: -------------------=-------- __________________________________________ !M-__ APPLICATION FOR SANITATION PERMIT Permit No. 45 &41 5.5^ - M {complete in Duplicate) ------------------------- ------ p'-.- This. Permit Expires i Year From Date Issued Date Issued Application is hereby made "to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made,in com �pl}iance with County Ordinance No. 549. P--!5,0— 01-60- 0 z JOB ADDRESS ANO OCATIO ;----€--r -y` . --s-- � s_ � ,... �'€ -------- „ Owner's Name., rll�cfi�J --- -- - ..� --------------- - -- ----------------------------------------- -- Phone--------------------- - Address es I�, ?= -----—------------- z - '- --------------------•---------- Contractor's Name----------•-.-1I-------•-------- ------•-----------------• --------------------------- -------•----•---- -_--------------- Phone----------------------------------- Installation will serve: Residence Aparfinen House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: )----- Number of bedrooms __-°3-___ Number of baths __-� ot size ---92---- __�___ _ --------------________ Wafer Supply: Public syste ❑ Community system ❑ Private)�n_Depth to Water Table ____ ft. Character of soil to a dep+Oof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ /Clay ❑ Adobe Hardpan ❑ Previous Application Made: al(If yes,date___________________} No New Construction. Yes 6, No ❑FHA/VA: Yes ❑ No P P ,�`-r TYPE OF INSTALLATION.AND SPECIFICATIONS: i ; t e u& C !�v 2- 4 y - P {Na septic tank or cesspool-permitted=if=public=se er_is--available-within 200 feet.``}��-r k Septic Distance from nearest well----n Distan e from foundation � --.Matt rI I.-, of compartments_--_- -------------Si- �J Liquid depth_______ _. Capacity-/-.5- lo. Disposal Field: Distance from nearest well _.-_Distance frorn�uncition______ ___-Distance to nearest lot line_ Jr _---_-Number of lines_____ ._ _ __ Len th of eae' - ;!_ __ Width of trench.____/ _�� _ - g ff i Type of filter materials /_ - -Depth of filter material-------- �-------- length---- __ ___----------- ..________ ff { Seepage Pit: Distancelfta nearest well---------------------_Distance from foundation-----._-.----------.Distance to nearest lot line------_-________ ❑ Number lof pits----:-"--------------Lining materia€-----------------------Size: Diameter-----------------------Depth-----------------•--------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ,}r Size: Diameter___ _____ _--__.__-_ Depth----------------------------------------- _____---_ ________________ _ _ -___Liquid Capacity- -_ . gals Privy: Distance from nearest well---------------------------------------------___Distance from nearest building ❑ Distance to nearest lot line_ Romodeling and/or repairing (describe)=----- --- ---------------- - ------•-----------------------------------------------•-------- ______________________________•_________________Iw_________________________--_-__-__-_-_----____________________-___________S____-_-____---________________-__--_____-___-_____ it __________________.___-___-__-- -----------------------____-----------------------------------------------------------------------------------------------------.__-_______-_____--..._____.------------------------------------------------------------------- _ J 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. (Signed)...� ------- ------------------------------------------------------------------------(Owner and/or Contractor) -.1----------------------------------------------------------------_---------- -( _ (Plot plan, showing size of lot,' location of system in relation to wells, buildings, efc., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- --------- ------ ---------------------------------------------------------- DATE--------------------- REVIEWED BY__ / �� ------------------- - -------------------------- ---- DATE---- ~� BUILDING PERMIT ISSUEb-A-------------------------------------------------- - T'_-___ DATE----------------------------------------- i Alterations and/or recommendations:----------------------------- ---- ----------------------------------------------------------•-•------------------------ ------------------•------------ ------- �---------------------- ---- ------ -----------------------------------------------------------------------•---•----------------•------------------------------------------ ----------------------------------- -- ------- -------------------------------- I------------------ --------------------------• -------------------------------------------------------------------------------------------- -------------------------- FINAL INSPECTION ----- ---------- Date-------------`--`---- 74/7.�� ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California R Manteca,California Tracy,California E5 9 REVISED H-59 3M 3-'63 F.P.CO