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OR OFFICE USE: , frl --------------F APPLICATION FOR SANITATION PERMIT Permit No. ....,&0 5-- ---------------------- --------- --- -------------- / ------------------------ ----------------- -- _.. (Complete in Duplicate) Date issued .__ This Permit Expires 1 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. 14 �. JOB ADDRESS AND LOCATION---:----- �------- -------------- ---------------------------- ---- _zV_tw --'_--------------- Owner's Name---- • �� A 1fr? ' r'S------------------ ------------- -------- --------------------------------------------- Phone_Aw7f6k1,V_ --------- Address o'i1st -1f7F11�- -----------------•------------------------------------------------------------------------------------------------------------ Contractor's Name---- - -------------------------------------------`--------------•-•---•---------------------------- Phone-./// :7--._ Installation will serve: 'Residence ❑ Apartment House Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -__. Number of bedrooms _ Number of baths __ Lot'size -_-Z ------------------ Water. Supply: Public system ❑ Community system ❑ Privateg Depth to Water Table W_ ft. _ Character of sail to.a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Co Clay Loam ❑ Clay 0 Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-- -------------..._) No x New Construction: Yes E] No X FHA/VA: Yes ElNo W TYPE OF INSTALLATION AND SPECIFICATIONS: / ..(No septic tank.7or cesspool permitted if pu bliCr sewer is available within 200 feet.) Sept' Tan Distance from nearest well___ .__-__.___--_Distance from foundation---------------------Material_--.----.._...-_____----___----_.-__---__--. �/lb !fes g No. of compartmr _ ents - - ---Size--------•------•----------------Liquid depth ------ - ----Capacity----- ----- --- Disposal Field: Distance from nearest .....Distance from foundation---jC?_r_.-__.Distance to nearest lot line----CS-_------_- Number of lines-'--------f-------- --------------Length of each line------/_-�Q_'---------.Width of trench----------- -`1�~._:__--.-_-- of filter material- �fC--------Depth of filter material-_-__f_&_"------Total length_- _'5/ Seepage Pit: Distance to neare;yst well----------------------Distance from foundation---------------------Distance to nearest lot line------------------ El Number of pifs.°4------------------Lining material------.-. .Size: Diameter____--------------------------- p Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_.- ...---__---_---.--------------._.. : , F1 Size: Diameter.---a--------------------------------#De th-----_------------_------ -----------Li uid Ca acitY ----------gals. Priv-Y . Distance from rr,e,,arest well--------------------------------------------------� - Distance from.nearest building ' .. ttonearest lot line--------------------------- - - ------------------------•-----•-•---------------------------- ------------------------------------------ Remodeling - ----- ------- --------- Remodelin9 and or repairing (describe):-----.rV,&A?-----. -------" � ------7-r->--- -------------------• '1 t S� ------------------------------------------------------------------------- -------------------•--•-------------------------------------- ---------------------------------------------------------------------..--•--------------------------------------------------•----------------------------- -- I hereby certify that I have prepared this application and that the work will be done in reccordance with San Joaquin County ordinances, State laws,,,and rules and regulations of the San Joaquin Local Health District. aD - =° ---- -----`------------ -- (Signed)----------- --- ------- - I caner and/or Contractor) Y••-•----• -- - ---- ------------------- ----------------------------{Title)- -- ----- ---------- ------------------------------- (Plot plan, showing size of lot, I ation of system in relation to,wells, buildings, etc., can be placed on reverse side). F DEPARTMENT USE ONLY APPLICATION ACCEPTED BY if- '----------------------= 4 DATE--------�/- G3 REVIEWEDBY------------ ------------------------------------------------------------- -------=------------- ------- ----------------- DATE---------------------------- ----------------------- 1 BUILDING PERMIT ISSUED------------- ------ DATE--------------------- ---------------------------------------- Alterations ----------------------------Alterations and/or recommendations--------------- -----------------------------=-----------------------------------------------------•----•--------------------•-- --•--------------------------- I ---------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------- i ------------------ ---------- -- --- - -------- ----•------- ------- ---------------------------------------------------------------------------------------------------------------------- ------------------------ all --------------- ----------------------------- FINAL . ..� INSPECTION BY------------ --- ----- ---- ----1114--7- ------------------ Date-------------- - ---��'--------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.DII. 4