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FOR OFFICE USE: y L + '.----------_�.........1.- y Permit No. APPLICATION FOR SANITATION PERMIT � (Complete in Duplicate). �- t. s ?j ............... This Permit Ex `ires 1 Year From Date Issued Date 'Issued'_..._ ...... ..�-. ------------------------------------------ Applicafion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Th�application is made in compliance with County Ordinance No. 549. itCW-/ 77q s KI�}s�� 0. 7ix 1 JOB ADDRESS AND LO ATION ---------------------------------•-- ------------- ��= Owners Name------- --•---- --------------------- ----------------- Phone--------------------------------------------------------- Address ------- •---••---•-----------••---•--------------------------------••--•--•--------------------------•----------------------....------------ Contractor's Name........ -- -- ------ ----------- ------------ ---------------------------------------------- !j % Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _17j--- Number of bedrooms --->3_ Number of baths ---q7�-Lof size __6.----�r-.�' �----- ------------------------ Water Supply: Publicsystem ❑ 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,ds ate------ -------...._.) No F New Construction: Yes-K No E] FHA/VA: Yes E] NoX TYPE OF INSTALLATION AND SPECIFICATIONS: Septic Tank: p Distance from nn'earest well'�.Q..... ..__Distance from found' 200 feet.) - No septic tank or cesspool •ermined if public sewer is av i fable �� ' � . '" -�'�� undation....��_!_-__.. No. of com artmenfs......._. �__......Size - _ _ ... -..._Li 1 uid depth--------I_7------- Capacity Disposal Field: Distance from nearest welL.:tiS .__..Distance from foundation-:...fd..._....Distance to nearest lot line----------------- .7-,:i ..loa-�-- s Number of lines-- --------- ----- ------ >� Ler;gth' ofjeach line-------7�_.'----------_.Width of french---------. f�__'.._.....--T- l Type..of filter material-_S r' _e Depth of filter material_ .fr'�-------Total length.........................�s�..__. ` # Seepage Pit; Distance to nearest well.�E��......_.__Distance from foundafiori.../.�----------D��a to nearest lot line ?- �.... Number of pits.:...... --------Lining material_*,5..!6L� -_Size: Diameter- Depth------------------r2-�...... i ' ------.Lining material---=---------------------- ----- Cess❑ool:► � Distance from nearest well.................Distance from foundation..... P - Size: Diameter------------`--- ----------------------Depth----------------- I-------------------Liquid Capacity-_-. Privy: Distance from.nearest-well----------------------------------------- --.__.._Distance from nearest building ❑ Distance to nearest Iof line---- -----------------------------------------------------------•---------------------------- -------------------------------------------- �? p Remod ling and/or repairing (descr.ibI e):.. ;� .._ - I} ---- • -" . ---`-- -------•---------- --- ----------------------------•----------------------•-- - ------------------------------------------------------------- - ------- ----------------- = -----------------------------------------------------------•- --------------------------------------------- 4 {-------------------------------------------------------------- � ---------------- -----------------•------------------------------ -------- ---------- ------------------------- I hereby certify that I have prepared this application and tha+ the viork will be done•in accordance with San .Joaquin,County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ;Pe ' F ------------------------------------------------------ --------------- -------- - ---------- -- ---------- ---(O ner and/or Contractor) (Signed) --------------- --- - r- r- t ---------------- By:----------------- ------ -_------� - -- -- ---------- -------------�---------(Title) --- - ------ (Plot plan, showing size of lot, location of sys`fem in relation to wells, buildings,'efc., can be'placed on reverse side). ; FOR DEPARTMENT USE ONLY I ----------- ---------------------'-`---'----------- DATE.---. ' = --------------------------------- APPLICATION ACCEPTED BY.._._C_,--�- --------:_ -� - REVIEWEDBY---------------------- ----------------- ----------------------------------- ----- - - ----------- DATE--------- ------------------------------------------------- BUILDINGPERMIT ISSUED--------------- ------------------------------------------ -------------------------�---------- DATE------------------------------------------------------------- Alterations ��---------------- 41,5., Alterations and/or recommends+ions:___'$::1.-_�a_�."`:.""`�S7R ,`_.---..-_� - -------------�-��- - - -------•-----------------------•----------------------------•------------------------------------------------------------•------------------------------------------------:------------------------------------------------ ---------------------------------------------------------------- -------------------------------------------------------------- �, --------------------- ------ •--------•-- -------=--------------=------------ -----------=--------------------------- ------------------------------------- ------------- ---------------------------------------------=-- ----------------------- ------ ------------•--- ----------------- ------•-------------------------------------- ------ ---------------------------- FINAL INSPECTION BY:------L ' S Date .....: SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hat:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Es 9 REVISED 8-59 3M 3-'63 F.F.DD.