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FOR OFFICE USE; - N - ----------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. /... .4;FZ { - ------------------------------ --------- --- ----- (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. 'gab �E.,. fr/T (�-� `/N1�1/T V -.IOB ADDRESS AND OCATIO J ��4jlap---------- ----------------------� %T i 2 Owner's Name---'------ -- w --•-------- ---------------- Phone------------------ V=- `5 ------------ ------•-• ------------------------------- ---------------------------------- Address • , Contractor's Name-------- ------ - i�'�`' ---- v Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer CourtMotel Other ElSII El F] Number of living units: _f___ Number of bedrooms _ Number o-baths /!Lot size ____.... .,/�--�i5.--� Water Supply: Public,system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Se 'I(No septic tank or cesspool permitted if public sewer is available within 204 feet.} ti ` p ank: Distance from nearest well Distance from oundation--//-p--------.Materia-_----____ Qfl?� .. No. of compartments_____--- ,[ --Size--- ••l�f�X- --X -"Liquid depth--------V------------ Capacity--- �ac - ----- O Dispo I Field: Distance from nearest well- Number __Distance from foundation.____�_�J.____Distance to nearest lot line��'__. Number of lines--------/..__` --_ Length of each line-------lU�__--_._______.Width of trench----- ^_ _--_-____________ f� , „ Type of filter material-__---'— ---------Depfh-of filter material__.___f _-_.._Total length_-____J._P _____________________ _A------ Seep e Pit: Distance to nearest well.-__--1�0D-_�.___Distance from foundation-------1_v_.._.Distance to nearest lot line________S__--FY Number of pits----------Y - ',-Lining-material-------- ...Size: Diameter----•-' --3--��---Depth_ -------�----------------Cesspool: Distance from nearest well-----------------Distancefrom:foundation.._._._._._--------.Lining material_.-:--____--------__________________❑ Size: Diameter-- -----------------------------------Depth -Liquid Capacity---------------------------galsPrivy: Distance from nearest well--.__---__________________________________`___-.Distance from nearest building____._____._______._______--_-___..._Distance.to nearest lot line_______________________ l-=I - ----------=-- C--------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe): r----------- -------------------1--=-----------------•--------•-------------------------------------------------------------------. -[ ----------- ----------------------------------------- ---------------------• ---------------------------- --------------------------------------------------------------------------•--------------------------••---------------------------------------•----_------------------ I hereby certify that I have prepared this application and thaf the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Lofal Health District. : [Signed]----------------------------- ------- ---- --- ------_ ..:_. . --------------------------------- -C-RL� z r Contract ) - --- - -- - ---- -- . - --- Title ------------------------- (Plot plan, showing size of lot, location of.system in relattori_to w.ells,_.bualdings, etc., can be placed on reverse side).. FOR DEPARTMENT USE ONLY Of APPLICATION ACCEPTED BY- = ------------------- DATE___,/_V,-___/7'_7�42- REVIEWEDBY----------------9*015---------------------------------------- --- - ='=----------------------r----- A-- ------ DATE----)_!_-A(7-'->------------- BUILDINGPERMIT ISSUED--------------------------------------------------------•--------- ---------------------------------. DATE-------------------------------------------------- ------- Alterations ------------------ - Alterations and/or recommendations:-------------- -- ------ ------- ----------- -----------------------•-------------------------------------------------------------------- --------- - ---- =--------------- ---------------------•--------------------i -: - = ....-•----------------•----•-----•-- =--�---•---------------...-----------------------------------•-------------------------------------------------------------- ------ ------------------------------------- = -------------------- --------------------- E � 't FINAL INSPECTION BY:.. -. ------ �� .. ------------ --------- Date---- - ----------- -------------------------------- SAN-JOAQUIN•L-OCAL.HEALTH.DISTRICTr,. - 1601 E.Hazolton Avi.• 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California } ES 9 REVISED B-59 3M 3-'63 F.P.CO. f S