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l--UK Url-K_t UJt: ................... ........ . ........................ .... ........ ------- _ APPLICATION FOR SANITATION PERMIT Permit No. ......... ......... --- ---- {Complete in Duplicate) This Permit Expires 1 Year From Date issued Date Issued &J.-7-4-7 P,pplication 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_... /..-3_.. -...&d.rd.-f------.._-______-_ Owner's Name.-A... Address-------------------t57-_2e-0._-P.... Contractor's Name.-------.. a_/111-P... .................... ............................... ............................. ............ Phone_.............. ............ Installation will serve: Residence [R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: .r- Number of bedrooms .. Number of baths -------- Lot size ......... ................................. .... Water Supply: Public system ❑ Community system ❑ Private JZ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan 0 Previous Application Made: (If yes,dgte .. ..... ..) No 64 New Construction: Yes ❑ No 4 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nea,est wel:.................Distance from foundation...................Material...................................... .-._-.... ❑ No. of compartments.......... ...............Size................................Liquid depth......................... Capacity.............. ..... .._ Disposal Field: Distance from nearest well.................Distance from foundation....................Distance to nearest lot line.......... ...... Guk IJ Number of lines..................... .... . ..Length or each I'ne..............................Width of trench.... ........................ Type of filter material.........................Depth of filter Material ..................... length.......................................... Seepage Pit: Distance to nearest well ...... .. ---Distance from foundation...................Distance to nearest lot line......... .. ❑ Number of pits......................Lining materia.......................Size: Diameier ........... Dept.'I_ .............. Cesspool: Distance from nearest well..... Distance from foundation.......... .... Lining material........ .............. ❑ S•ze: Diameter........ .. .................. Depth.................... • •- .....................Liquid Capacity. ----•-......---------•--..gals. Privy: Distance from nearest well ...........................................Distance from nearest building.......................................... ❑ Distance to rearest lot line...........................................- ---•---•--`-..._.................--j---......---.. .................... -\ � Remod lin an %or repairing (descrice):_ �7. .......7 !.T().t t�1 �ll.l�-5 �I E Vtr 1� �' ) C D'311y Q C - §-' ` -, - ....-----._............I.............................. .............. --•--- -- ............E............... .... ......•----- ................................__.............................. . .............................._•----------..-............ ---.... ..........................................------. --------------------- - - -- - --- - - --------------------------------------------------------------- ------------------------- -- -- .............................................. --------------- ---- -------•----------. .... -....----.. ........._...._... 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)-------. /L IJ �I/K`. . --- --..-. ��1��1/t :�l%....._-.---------__...-.................. (Owner and/or Contractor) t By:---- ................. ------------------------------------------ ---- ....... --...._(Title)...... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT U E ONLY APPLICATION ACCEPTED BY. .... .. ......... ....Cs'�/�. � ,----.........--.---....... - DATE..- -� ..2.,e�......112-�___....... REVIEWEDBY.... ... .................................... .....I...... ......................... ..... DATE---............................_.................. BUILDINGPERMIT ISSUED...................................................................................................... DATE.---.........................--- ..................... Alterations and/or recommendations:_ .. . .. .................................................................................................................... .. . ......------- . —...................................................... ..... .................................... .................... ....... ... . . . . ................................................................ ..............................................................•-----.._....................------..........._........---------•....._......---•----------------------------•--------••---........._._...------..... ...... .:.............................................................. ...... ... ..._...I..........._...._....-•--_._._....._._............_.................. .. . . ..... ............................. . ........... .... ................................................. ........................•-----.---------------...._................................. ........... . ...................................... ... . - .......... FINAL INSPECTION BY:......_.e..... . . ........ _.. Date__......._._....._. ...-.......... . . .... .._ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Sheet 124 Sycamore Street 405 West 9th street Stockton, California Lodi,California _ r Manteca,California Tracy,California r.r.a a.