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--------------------- -.� ----- ------- _------------------------------------_-_ APPLICATION FOR SANITATION PERMIT Permit No. = --------------------------- --------------- ------------- " — w (Complete in Duplicate) _ 5— i This Permit Ex fres 1 Year From Dae tIssued - - - Date Issued Application is hereby made to the San Joaquin Local Health District for apermit to construct and install the work herein described. This.a,pplication.is made in compliance with County Ordinance No. 549. JOB ADDRESS AND x2.r `: /art t � r_.�� S Owner's Name_"'______ _"" r _- c~ Phone Address_ Y � - Contractor's Name _ (/ --•-------------------- Phone-•--------- V_ Installation will serve: Residence Apartment House ❑ Commercia'I .❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: __1___ Number of bedrooms __ Number of baths __ -___- Lot size ------------------ to _ __ -_ __-_. Water Supply: Public system ❑ Community system � /�� pP y� Y Y ❑ Private Depth to Water Table-�ft.C� Character of soil to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam ❑ ClaY Loam Ej Clay l I Ad dobe ` Hardpan El Application Made: [If yes, pte____ _______] No� Naw Construction: Yes (� TYPE-OF INSTALLATION AND SPECIFICATIONS: ❑ �O FNA/VA: Yes ❑ No (No septic tank or cesspool permitted if public sewer is available within 200 feet.] 5V^I •�� „�� d ._. •. ter--, .». ,,e-."-.--- Septic T61g. Distance from nearest well - a.�----- - -------------Distance from foundation-----------_•------.Matersal-_____"-__""__""__-"--____--- ' NoF.. of compartments-------- depth-------------- Disposal Field: Distance from nearest well---- _-Distance from foundation•__-ZO__•":Distance to nearest lot line_-"� `4 F Number of lines------ N-Length of each line--- --------- Width of trench--- -- -- ------ h Type of filter materia!_ [' w 9 - - -�_ ��-?�-�' Depth of.filter,matenal___ ff�"-____-_-Total length------�t�_1 �__-__________ � 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______________y Distance from foundation-----------_- ❑ Size: Diameter--- I------------------------ ----Depth------------ ------ ---- i ter y_.. -------------------------- .,•Lw. ,, = Liquid Capacity ----------------------- gals. ,-d,Priv - ._•..-_ .._,� -- Y Distance from.riearest welh_r _ ' �'� -- Distance from'"rlearest-buildiiig ------------------------— El �. . Distance to nearestlot line__.-__ ------------------------------------------------------------------------------- ------------------------------- Remodeling and/or repairing (describe): -----"__------------" f ------------------ -- ------ -- >� --------------------------------------------------- __-___-_____-___:.___________________________________________________________________________________________________________________________________________________________________________________________ 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. i (Signed)_�__ r ).i, ----------------(Owner and/or Contractor] Plot -.Ian; shoWin size of-lot—, location location- By:------------ - ; , (Title}--- -------------------------------------=--------------------------------------------- ( p g of systerlti in relation46—wells;buildings,--etc.;can-be-placed on reverse-side).Y= r �= FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-_---_._ --- DATE_ REVIEWED BY ------------ -------------------- ------------- ----•------------------------- 7 l2 ATE- ,�= - BUILDING PERMIT ISSUED----•------=-- T ------------------ Alterations and/or'recommendations:______;________________ T -- DATE------w----------- Alterations } -------------------- -----------•----------------------- ---•------- - ---------------------------------------- ---------------- ------------------ ----------------------------- ------ ---•----------- ---------- ---------------------- -- FINAL INSPECTION BY:___ --------- — - - ........................... Date__ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 285 West 9th Street Stockton,California Lodi,California Manteca,California ? Tracy,California E5 9 R6V15 ED 8-59 3M 3-'63 F.P.Cp,