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OR OFFICE USE: - c�------------------ ��= f --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .l_. . ---------- - (Complete in Duplicate) p/ : -- N- - Date Issued _ , �_ _ ____________________________________________________.___ This Permit Expires 1 Year From Date Issued Application is hereby made to the SanJoaquin 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. jd-� _ �,p. Z2 f�7 Ir8 „j-.,�rim r ).,"- JOB ADDRESS AND LOCATION---At"�------ e -----------------------------------••- ��_L E F- -------- -------------------------------------------------- ------ •_ a,►4NV, Owner's Name_ W1_e11,A----- V�' ` ------------------------ -------------- Phone.. - S Address----------------} '3©S -- .-•:---- r_ _k at ' -—---------•------•--------------------------------------------------------- W} --.-...----- ---------------------••---- Contractor's Name---- � 43k--r-t -,s------4-twe--t--------------------------------------------------------------------------------- Phone__ Installation will serve: 1 Residence ❑ Apartment House ❑ Commercial ❑ Trailer-Court ❑ Motel ❑ Other ® /—,gso+e. &P,*..o Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -----------fi-cP _ _C6-__--__:___._____________ Water Supply: Public system .El.. Community system ❑ Private Depth to Water Table _/S--ft. Character of soil to a depth of 3 feet:r Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan p ❑ ❑ y ❑ Y y ❑ ❑ ❑ Previous Application Made: (If yes,date--------------------) No [g New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ Nox TYPE'-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p Septic Tank: Distance from nearest well---------------- Distance from foundation___________________Material--------------------------.------------.________- ❑ No. of compartments--- - ------------------Size---- := "`----=: --------Liquid depth---•---------------------r-Capacity--...------•----------- Disposal Field: Distance from nearest well__1_,c:c+.'____Distance from foundation.....1_0._'______.Distance to nearest lot line----,s----------- ------ __________ Num6er of linas5- `''�- ` _'""__`-Lengtli of each"Tirie______� -`T _s__r�.Widtli of trench..s___ p._____._.______ p ca.( ,Type.of filter material.._�_.__ '�_��4__Depth of filter material______I_�_`'_.s. .=Tata) length_! ..'_____-__:_/Aa_'___________ �- Seepage Pit: distance to nearest well----------------------Distance from foundation___._____ ____Distance to nearest lot line----------------- 3 ❑ Number}of pits---- ---� Lining maternal == Size: Diameter '17 Dept 4.4 Cesspool: Distance from nearest .well_:_;`__�_7_J Distance from foundation.__.,_- __-.Lining material:______.___________________________ - -rte .. - ❑ Size: Diameter--------------------------- ----- ----Depth-----------------------------------------------------Ciquid Capacity....=-----------------------gals. .. Privy:: Y t;Distan le..from,neareO well-----'_----------------------------------___-.`N-"--bistance.,from-nearrest building____---------____________________________ Distance to nearest lot line------------------ - 3 ---------_------------------ ------------- -------_------------------ and/or repairF 9 (descie _._._:_ � ��!`` `7. - - ' 5 = ------:-----------•--•------•------- Remodeling _ y ---- =-- -_ ---------------------------------- -------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in:accordance•mwith San Jo'Squin County ordinances, State laws, and rules and'i"egulations_of the San Joaquin Local Health District. µ (Signed)--- _! _l.. -`l_..-I-- s�" ' -------------'--------------------------------------------------------------------------------(0 ner and/or Contractor) 9 -------------------------- (Title) Y--------- -- -- --------------- (Plot Yc }plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]..,. f 1 `` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -` = - -- - ------------------------------------------------------------ DATE-- REVIEWEDBY ------------------------------------------------------ - ---•--. DATE'-•- --- - BUILDINGPERMIT ISSUED------------------------------------------------------- ------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------- --------------------------------•----------------------------------/- ----------------- -------------------------------------------------- . ° ------------- ------------------ -------•------------------------------------------------------------------------------- •-------------------•---- f. FINAL INSPECTION BY:---- "---=-- �"---------------- ----------------- Date_-- 6" --f------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9-REVISED 8-59 3M 3-'63 F.P.CO.