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R FOR OFFICE USE: t -------------------------- - ----- l67 ) + d APPLICATION FOR SANITATION PERMIT Permit No. ------- - .v` ---------P"' ------------- ----------------------------- ----- (Complete in Duplicate). . -- _ Date issued'--,1�-��------�� I ----------------------------- 'This Permit Expires 1 Year From Date Issued r 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. ++�� pp '--------------•-•-----•------------------------------------------- JOB ADDRESS AND LOCATION.'-.07- ___9---- r_-- --- Owner's Name-------- --. �-` +' � Phone.-,-,.------------------------------ ---------------------------------------------------------------------------------------------------- �._ ----------------- ------ I Address-----------�s7r'G-->7_7,e..... --------------------------------------------------- Contractor's Name-----•-----____ ev lELr lir ----------------------------------------------------•------------- Phone----------------------------------- Installation will serve: Residence ®/"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other ❑ or Number of living units: _/-__ Number of bedrooms___ Number of baths _/---- Lot size --- -I.-�------------------------------- Water Supply: Public,sysfemi [� ommunity system ❑ Private ❑ Depth to Water Table I> e- ft. Character of soil to a depth of 3 feet: -Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [3Adobe 1lardpan C] Previous Application Made: {If yes,date-----------7........I No 9��New Construction: Yes ❑ No FHA/VA: Yes ❑ No A.— TYPE —TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank' . - Distance frominearesf well________,______Distance from foundation__________________Material------------.-.-_____________-_______,____.___. p - /J��' No. of compartments'x ----Size--- ----..: !� ----Liquid depth`°. _Capacity Disposal Field YDistance;from nearest well__._---- --.Distance from foundation_-_cif----------.Distance to nearest to line____________ - s Number of lines"________ ____ __ _Length of each line->9 ___________________Width of trench- �y f {� Type of filter m'aterial� ___�C ---Depth-of,filter,materiaL_ "--__._TotaE 1eng+he: _-_•__________________________ Seepage P :. Distance to nearest well------- �m fouridation__-.f�__.___.Dista�� to nearest lot ` ! __Linin rrlaterial Pt� .Size: Diameter___.7� _ Dept ------ ��' t �T Number of pits.------�------�---- 9 ----- - - --- -- -------- P I } Cusp Distance from nearest well---------------!Distance from foundation------------------- .Lining material----------------------------.-------- 5izei Diameter------ --- -- - - ------ ❑ � ,-- -------------f Depth----------------------=------- ------------- - ----Liquid Capacity ------------------------gals. Privy: Distance fromIxiearest well-______________ _____________________________Distance from nearest building----------------------------------- ❑ [ Distance to nearest lot line------------------------------------------------------------------------ I - i Remodeling and/or repairing (describe):-------------- ."40olem fe---"---------------- ------------------------------------------------------- t ; I t --------------------- ---------------------------•-------•------------------------------------------•-------------•----------�------------------------- ---------- --------------------- - ------------------------ ----------------------------------------------------------------------------- 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 Locdl-Health District. I i - ri # yContractor (Signed) -------=------------- -- ------------------------------------------------- gd ' ------------------- ' -----------------------------------------•---------------------------- -- --� - ------------------------(Title)----�/� . (Plot plan, showing size of lot, location of system in r tion to.wells, buildings, etc.,.can be placed on reverse side). # r . t FO'k DEPARTMENT USE ONLY APPLICATION ACCEPTED B ---- --•---------------------------------- DATE_IB- ---•----------------------- REVIEWEDBY =� - ---------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------- ---------------------–-------------------------------------- DATE- -------------------------------------------------------- Alterationsand/or recommendations:---------- ----------------------------------- -----------------------------------------------------------------------------------------------.--- ------------ 1. r ----=--------------------------------------------------- -------------------------------------------- -------- ? ----------- -- ----------------------_-- ---------------------------- ------------ ----•-•--------------------------- ------------------ ----------------------------------- -------------- -----------•---------------------------------- ------------------------------- - r s- FINAL INSPECTION BYX— ._:.. - - ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street d 124 Sycamore Street 205 West 91h Street Stockf*n,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 31A 3-'63 F.P.CD.