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FOR OFFICE USE: CA C/t-0�, ------ --- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------ ------------------- ------------------------------------------------------ (Complete in Duplicate) -------------------------------- ----------------- --- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein 0'escribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIONAX-2.... W. ------------------------------------------------ P , , , __- Owner's Name..._�.v ----------- ......• ...CA1 -L----------------------------------------- Address-----------------C-.SA 1 ................................................................................................................................................................... Contractor's Name.........pZr'.W�. - ...... ------------------------------------------------------------------------- Phone.1-t0_6Af Installation will serve: Residence X 'Apartment House E] Commercial E] Trailer Court 0 Motel 0 Other E] Number of living units: A---- Nu'mber of bedrooms Number of-baths J---- Lot size ............................ 01 Wafer Supply: Public system JK Community system [] Private F] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand C] Gravel [] Sandy Loam X Clay Loam [:] Clay E] AdobeC] Hardpano 0 Previous Application Made: (If yes,date--------------------) No New Construction: YesE] No FHA/VA: Yes o NO TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation..............__.Material------------------------------------------------- El No. of compartments------------------- ------Size-------------------------------Liquid clepth---------- ---------------Capacity----------------------- Disposal Field: Distance from nearest well__A0e_JVfDistanc6 from foundation.....Z .......Distance to nearest lot line--_--47...... Number of lines-----_1- - ------------------Length of each line......__"_ __#----------Width of french-------".1----------------- Type of filter material__ 0411_144-------Depth of filter material---Z--- length-----V9:0_ A.............. Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line_---_---_._._--.- _ ❑ ine----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter._---_.-.--..--._----.-Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance fiom foundation----------- ---------Lining material.-----_----._--_-----.--_--____--_. ❑ Size: aterial-------------------------------------- Size: Diameter--------------------------- -----Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------- -- ......_-------- ------------------Distance from nearest building--_-----_----_-___--____--_--._------_--" ❑ Distance uilding------------------------------------------ Distanceto nearest lot line------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):---i--------- _``p...... ...4L.-A -------------- ,,-4 .r..- Z01S. M....A--------------------------------- -------------•----------------------------------------------------------- --- --------..............-------- -- ---- --- _------------ --------- - -- -- ------- -- 1------------------------ ----------- --W........ ........... --- -------- ------------------------------------------------------ --------- I hereby certify that aye prepared f Wiapplicoi n and thate 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)...-----------------P" __---,7- ------ ------- --------------------------- -----------•--------------------------------------------------- -------(Ow er and/or Contractor) By:---------------------- co,�. ..... ___________________________________________(Title).....---.--_ ------------------------------------------(rifle)... ------ ------I-------------------- tion of Sys buildings, etc., can be placed on reverse side). (Plot plan, showing size of lot, location 4e i in relation to Wells, I FOR DEPARTMENT USE ONLY APPLICATION.ACCEPTED BY--------------------------- ---------------------------------- ,,q- DATE REVIEWED BY_----------------------------------------------------------__------------------ . - - . 1� ......... ............................. BUILDINGPERMIT ISSUED------------------------------------------------- ------------ ......)------------------------ DATE------1�------------------------------------------------------ Alterations and/or recommendations:------------------------------ .........................................................=- ........................................................ ............. . . ....................... --------------------------- - ---------------------- ... ---------------------------------------------------------------------------------------- -------------------------------- -------------------------------------------- - --------------------------- - ------ -- ----------- ------------------------------------------------------------------------------------ -------- -----------......... JF -------------- FINAL INSPECTION BY---------------- --- Date------- ------- .----- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton 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.P.120.