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FOR OFFICE USE: ----------------------------- ------------- ----- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. lid---- ---- --------------- --------------- -------------------- (Complete in Duplicate) Date Issued _/11 ---------------------------------------------------- --- This Permit Expires I 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. JOB ADDRESS AND LOCATION_____ -- ---------------- ---)---b.-- Owner's Name------- - --- 00 iC'?4--- Phon --~-�- -------------- - Address �� ------ ✓ = `- - Contractor's Name----------------- --- ------------------ Phone------------------•--------------•- 1 - Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Y_ Number of bedrooms _ - (Number of baths -- Lot size --------------- -x" �--- --/------- Water Supply: Public system Community system DI Private ❑ Depth to Water Table 6' ft. Character of soil to a depth of 3 feet-.f:��d Gravel El Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe E] Hardpan ❑ Previous Application Made: (If yes,date,712�!_61j-3) No ❑ New Construction: Yes 2-11'o ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k: Distance from nearest well__!-- ___--stance from foundation___-__! .."-.-Material_ No. of compartments-----------�--------Size----� -e �7 iquid depth---------- /-------Capacity--- -------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- r El Number of lines------------------------------------Length of each line-=--•----- ----------•-------1Nid-th of trench------------------------------------ + Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ 0 Seepage Pit: Distance to nearest well.- -------------------Distance from foundation-----------.--------Distance to nearest lot line----------------- ❑ Number of pits--------------------.Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------ Lining well materia)---------------------------------9_al-s - . El Size: Diameter - - Depth- -- -_ ----------Liquid Capacity - 'Privy: Distance fromnearest well--------- - --- - - -- - --- --Distance from nearest building ---------- -- --- ❑ Distance to nearest lot line----------------------------------------------- ------------------------------------`----------------------------- ----------------------- Remodelin ate n"d/or repairing (describe):----- � - `y � d/ c� ------ ---- c� 7 - "r -c ��----- ------------------------- �`L�.w_ - — 1� •�--�d c� � � =Ci ti _ r c1 ` -----------------"--------------- 1I .e --------------------------- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San JoaquinCounty ordinances, Sf laws, and rules and regulat' ns of the San Joaquin'Local Health District. � ��.., t� 61t 4 (Signed)-'X-- ------- ----- ---- - - T - ---------------------------------Owner and/ Contractor) + Title t B •------------------------------------------------------------------------------- -------- - I ' ] T (Piot 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---------1/Z/; ----- --- --- ------------------- ---------- DATE------------------------ _ '---------- - REVIEWEDBY----------------------------------- - - ---------------------- ------------ -------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations; �` �--.......:7— -- ----------------------- �---'--"---- � t -fit 72� - C c�� -----.oma r_1r— ---� ----- - - [ -------- --- -------------- ----------- 'C� -------------------•----^---------------------------- ---------- ------------ -�---- -- Cr_ t� E ter°.. ��-- - - n � � - -------t -------�------- ,rr '--------- -- --✓ ---- ---- - ----- FINALINSPECTION BY----------------------- ------------------- ------------ Date-- ------•--------------- ---------------------------------------------- SAN' JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasdtan Ave. 300 West oak Street 124.Sycamore Street x205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 REVISED 8-59 3M 3-'63 F-F-CU•