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FOR OFFICE USE /1��c�-------------------- --- --�=3 b ----------------- ------=---------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------- - ----------•- ---- --------------------------- (Complete in Duplicate) :._,.Da#e 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 descrbed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.---- -/- ...-4i -�r Q E = -----=----------------------------------' Owner's Name------------ate rl- --`------a-- -----• - _ - ---- Phonea�.? (� +� �+ "71 Address.- h ,rte:!-Qr •.. Contractor's :, __f -•----------------------------------"--•------------------- Phone �?_ _� Q�7 Installation will serve: I Residence ❑ Apartment House ❑ Commercial gc Trailer Court ❑ Motel ❑- Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Low size ____________-______'______________________._________.____ Wa+4 Supply: Publli,`sysfein 5d Community system E] Private ❑ Depth to Water Table -------- ft. Character of soil to a depth6 f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made:%(If yes,date_........_----------) No New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ No;S> TYPE 'OP INSTALLATION AND SPECIFICATIIONS: ', _ % (Nos septic tank or cesspool perrrmi+ted if.public sewer is available within r200 feet.) Septic Tank: Distance from Barest well_________________Distance from foundation--------------------Mater�'�_______._"__.______.__ • -------------- ❑ No. of compartmenfs--------------------------Size---------------`--------------•-Liquid depth-----------7�-----------Capacity----------=------------ F _ F pisposal Field_: Distance from nearest well:..___--_.--mDistance from foundation.-."_________-__.-.Distance to nearest lot line_._:___.__._____ ❑ Number of�lines Length.of each line - W'sd_h of trench---=----------------------------------- I \SA`�-T pe'of filter'material-------------------------Depth o filter material------------------------Total 'length----------------.:--.----__----`~ r- E See ag e Pit: Drstan,?'ce to 'neatest ell__-_ ,f�_________________Disfancem foundation________•_ . n—, _-_-___.Distance to nearest lot line ---__._._ }� [ Number of pi /- ------Lining material-- Diameter._. _`.,____.Dept h_._. --f-------------- C Cesspool , Distance fromti,nearest well________-_______Distance'from foundation____________________Lining material_-_ - _j----------------- - -----------------------------�. aIs. ❑ 1Size: Diameternearest wel --------------Depfih----- - ' ---------------- ----- -------- � Liquid CapacitY --g a f 3 Privy: Distance from l-____._._____�!___ ---s._ __.___;___Disfance,from 'nearest building------_____________________r___.------ ❑ Distance to nearest lot line---------------- ` ---�----------------- ------------------------ ------------ U` Remodeling and/or repairing,{describe):--, f/ -/'/_C? ---Q,, XI/.etl C _- -- ----`-r--- -- -- ----=------------- l --------- - , ------------------------------------------------------------------------------------------------------------------------------------------------ - ' -----------------------------------------------------------------�--------------------------- '--- -----•------------------------------•-----••----------•----------------- --------------------------------------------------------- ----------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- =------------- 1 hereby certify that I- have prepared this application and that the work will be done in accordance with San Joaquin�County ordinances, State-la andruulles and regulations of the tan Joaquin Local Health District. (Signed) ------- ------ 1 f X C�------------ - (O er and/or Contractor{ BY' - - --------------------------------------------- (Title) (Plot plan, sho g size of lot, locaon of system in relation to wells, buildings, etc., can be placed on reverse side). l FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY- -------------- DATE--- ,�1 �>/��Lf --------------------- REVIEWEDBY--------------------------------- ----------------------------------------------------------------` DATE----- ,: BUILDING PERMIT ISSUED-------------------------------------------------------- --------- ---------- DA.-TE--- Alterations and/or recommendations:_. / ....._. ~ - � ��=c•--��--• � -�-• "-"----- ----------------------------------------------------------------------------------r ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----- ------------------------------- - . i ------------------------------- FINAL INSPECTION BY: --------- - -------- - Date....... `% cam - SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street stockron,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3-'63 F.P.CC.