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FOR OFFICE USE: _ -------------- -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. __l_.. _ .3_fO -- ------ -- - ----- - ------ (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued �-A, 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 AN L A ION ------------- ---------------�--,-•-c--------------------------r----- r �—ntq / v AV k/141 w� 7�. �SOwner's Name---------------- ---------- -- _ - 9 Address-P_4.u- - $.. .1111xr _ Contractor's Name .. . ------------------------------------------------------ ----------------------•--•----- Phone"944-`--17/-A- Installation will serve: Residence ❑ Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- - ___ Number of bedrooms .&_ Number of baths -4--- Lot size . // ______________________ Water Supply: Public system x Community system ❑ Private ❑ Depth to Water Table!-¢- ft. Character of soil to a depth of 3 feet: Sand V Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------.--------I No ❑ New Construction: YesR No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: # (No septic tank or cesspool permi+ted if_public sewer is available within 200 feet.) Septic Tank: Distance from nearest we11 '____dXJK__ _Distance from foundation_,-.�..........Material__ ________ _________________________-._-__'_.D No. of compartments--- -------._.__Size� h.S'___Liquid depth_.9 -------- CapacityidQ .�y��,�� 09 Disposal Field: Distance from nearest well..!T.C.Distance from foundation_,/-40----------Distance to nearest lot line..__._.__. Number of lines------57_________ _ ____ _ Length of each line ----.. - ----_ -�___._.Width of french.3_�_5". Type of filter material.-! Depth of filter materi �_8_____-___Total length-------�,Z__'dA_. � t Seepage Pit: Distance to nearest well----------------------Distance from—f undation--------------------Distance to nearest lot line-----__r__.-_-_. y ❑ Number of pits----------------------Lining maferiallJ------------Size: Diameter-----------------------Depth-----_---------------------__.--• Cesspool: Distance from nearest well_______-_ . istance from foundation____._________._..Lining material____________________________________. ❑ Size: Diameter---------------------- - ,Depth--------------------:_ .. -- ---------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest w _______________________________________________Distance from nearest building._______________________________.___..__. ❑ Distance to nearest lot me------------------------- --- ----------------- ----------------- ----------------------------------------------------------------------- Remodeling and/or repairing (describe)----------------- �� ` �� 7� �� `� ��r�----------------------------------------------------- - ---- ----------- ---------------------- --------------• �Iawsa,.and --------------------------------------------------------�---------------------------------------------------------------------- -------------------------------------------------- I h ebythat I have prepared this application and that the work will be done in accordance with San Joaquin County ordina aules and regulationsof + San Joaquin Local Health Distric#. 4".(Signed)- --- - --------- - ------ ------ ----------- -- ------- ----- wrier and/or Contractor) - -------------- -- Ti (Plot plan, showing size of lot, location of system re ion to`wells, buildings, etc., can be placed on reverse side). �,.�— FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- f--� RA= �a------------------------- -- ---------------------------------------- DATE----------6-. p- ------------------- REVIEWED BY--------------------------------------------- ----- ------- DATE- BUILDING PERMIT ISSUED---------------------------------. "`_%� .,..., ----------- DATE------------------------------- ------------------------ Alterations and/or recommendations-------- ----------------------------------------------------------=-------- -----------•------•---------•--------------------------------------------- j --------------------------------------------- ---------------------------------------- =----=--------------------------------=--------• --------------------------------------------------------------------• -----------•-- ---------------- --------------------------------------------------^-----------------------------•----------------------------------------------------------------------•--------------------- ----------------------------- ---------------------------------------- -- ---------- --- -- ------------------------------------------------------------------------------------------------------------------- -.. - --------- = - ----•------------------------•--------••--------------- ------------------------------------------------ FINAL INSPECT Date- L_-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hax*lton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California £S 9 REVISED B-59 3M 3-'63 F.P.CO.