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, 17 FOR OFFICE USE: � � ��t UIS�'�_ j,J7 --------------------------------------------------------- 1 APPLICATION FOR SANITATION PERMIT Permit No.zz(... _ --- ---- --- ----- (Complete in Duplicate) Date Issued 15^AV414 -------------. .- ----.-. -._-. . --.--- 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. JOB ADDRESS AND LOO CATION---�---y-�---�----------•-- - `_ �� -' z`= Owners Name........ ..j.........-- ----�--�•-•----------•-----------------------r---z-------�--------•---•-••------•---------t-- ---•------ Phone-----••-------------•------•-------- --------------------Address-----•--•••-• -� l ...............................- . .......................................................... Contractor's N .� .._: z t U'...-- o_��: •° .4+ . --- • -••-•--- Phone................ Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms _Number of baths ---I--- Lot size .......SL�K.1_p_.Q.............................. 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--------------------) Noj4_ New Construction: Y �_ Plo ❑ FHA/VA: Yes ❑ 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.------__---_.--__--_- _-____---_--..-__.---. No. of compartments--------------------------Size-------------------............Liquid depth--------------------------Capacity---••- ----••------•--- *1isposal Fiel r Distance from nearest .-Distance from founds i n.__.. 0......._.Distance to nearest lot line____,.... 0 Number of lines----- --- - - --Length of each line_� �.. Width of trench. x `� == /r -------- --5 -------- � Type of filter matenal.___.�--�-"�>__Depth of filter matenaL._�_�__.•_..______Total length----- ._..___.__ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth__--.---.----_-_--_-__-----. - Cesspool: Distance from nearest well-----------------Distance from foundation_-----------------Lining material-_-----_---.-_--__---_-_-_-______-_-. �1f ❑ Size: Diameter----•---------------------------------Depth---------------------------------------------------Liquid Capacity---------------------......gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---_---------------------------------_ _. ❑ Distance to nearest lot line------------------------------------ --------------------•------- ---------••--•------------------------------------------------------- Remodeling and/or repairing (describe): ---------_------------- z_ .�_. ----- --- -•---------------•------......... -------•----•--------------t-----------------------------e----- --------- ,----`==f�- .'..%--.!_il_i�:_..__ :".rKb!�c.: /Si.?�t�[� :'X:r -----�= �.�- ,---r-�F ------ -- --- -- ---- -- -• ------- --- - - -------------------------------------------------------------------------------------------------------------------------•--------------------------•------•--------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S# laws,,and rules and regulations of the San Joaquin Local Health District. ..� _r (Signed) - --------------------------------------------------------- (Owner and/or Contractor) r 1 8�----� =---- -----tr/>----------''--------------�-----------------------------------------------------------------(Title)--------------------------------- ---•- - -----------(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). W FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------------------------------- DATE----------------- ----------------- REVIEWEDBY---------------------------------------- ------------------------------------------ fi DATE `.I BUILDINGPERMIT ISSUED--------------------------•------------------------------------------------------------ ---------- DATE-------------------------_--- ----------------------------- Alterations and/or recommendations:---------------------------------------- ------------------------------------------------•------------•------------------•-----------------------------•- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------- -------•--------------------------- -------------------------------------------------------------------- --------------------------------------------•---------------------------------•------------------------------------ ------------------------------------- •--------- ----------------------------------------------------------------- -----------•-------------------------------------•---------- ------ ---------- ------------ - ------------------------------- ------ -----------•-----------------------------.--------------------------------------------- FINAL INSPECTION BY:. cam- 9.r Date-------- --,---- �3 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 95 9 REVISED 5-59 3M 3-•63 F.P.CD.