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Ar FOR OFFICE USE: ------------------------ ------ ................._-......___.--.--..__-....___---..__- APPLICATION FOR SANITATION PERMIT Permit No. .... � --- - ------------------- ,2.-------------------- (Complete in Duplicate) / 2 , ---------------------- This Permit Expires 1 Year From Date Issued Date Issued --- Application _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 OrAinance No. 549. y'� 1 JOB ADDRESS AND LOCATION__-___4 i/\; r ! t t. � Owner's Name --------•-t 1.• .1 !12 ' Phone. ----•------------- ------------------- --------------------------------- Address.. ------ Address..--------snz_ = Contractor's Name ` -(- Phone-----------------------••-•-------- Installation will serve: Residence (; Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _---[-?Number of bedrooms ---9- Number of baths -_7�Lot size ..-2-. -49-- -_____________________________ Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------------_.) Not4_"New Construction: Yes [[ No ❑ FHA/VA: Yes ❑ Nom /} TYPE-OF INSTALLATION-AND-SPECIFICATIONS: --;;� -- = - _ �_- _ (No septic tank or cesspool permitted if public sewer is available within 200 feet) � n Septic,Tank: Distance from nearest well_.--! _--Dista e-from foundation....................Mat real. . -�-l_c __. ____-:':_______. No. of compartments---- — ............ S.ze._— 5"=----Liquid de th------ ----------Capacity-- Disposal Field: Distance from nearest well_1100....Dista ce from foundation--------------------Distance to nearest Number of lines---._.�---------------------Length of each line------ xS------ tc.Width of trench-------- /_. ............. Type of filter material----S.�r?e-kDepth of filter material--._.-../--k-_-..-_Total length_-.y`LX?d Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------.-----.Distance to nearest lot line----------------- + ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------------------__Depth--------.----------------------- 9 Cesspool: Distance from nearest well-----------------Distance from foundation-----_--------------Lining material..._.-_----------.._.._-._--_-.--.__. ❑ e: Diameter----------------------------- -------De th--------------------------------------_ ..........Liquid Capacity--- ------------- ---------gals. _ _ ..» Priv Distance from nearest Well—............_._.-_'____._-.-._._.-.........Distance from nearest building........___-.........._____.........._ ❑ Distance to nearest lot line Remodeling and/or repairing describe :..= �_ _-_ _... ` C �J " 2l- _ �•Q-.rte .�.�:-�-�..� - � .: 7 - .. ------- --------------- ------------- � --- �..._..�.�_�:--. 1 hereby certify that I have prepared this applicafi ri and that the 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)----- ------- .- ------------------------------------------------------------------------- ------(Owner and/or Contractor) ----- y" T=---=----:- -3-��--{3�-- -=-- ---- --- - - - --- ---- --------_(.Title -=_- F ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ~ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- ------------------------ ------ E - DAT REVIEWEDBY ------------------------------- ------------------------------- •-------- --------- DATE-------------- f~'III BUILDINGPERMIT ISSUED------------------------------------------------------ ----------------------------------•- --------- DATE.----- Alterations and/or recommendations:---------- -•----------------------------------------------------- ' ------- ------------ --------------------------- - ------------------- ------------•------------------------•--------------------•---------------------------•-------------------•---------- ---- -•------------------------------------------ ------ --------------_......------------------ -------•------------ ----•-------- - y FINAL INSPECTION BY:-.---------------- -- Date- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California IES 9 9trV15EP E3•513 31A 3-'63 F.P.CC.