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{ FOR OFFICE USE: ----------- - --- - ---------------------------------- --------- -----------------------I----- --------------------------------'____________________________________ _____!� APPLICATION FOR'-SANITATION PERMIT Permit No. ..�.(.3_�8 - -- ------- ----------------------------- -----------` (Complete in Duplicate) � �/(� S This Permit Expires I Year From Date Issued T bete Issued .__ ________III__ 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. <y 2-12- -70 w4l 7Z.75/ } JO ADD ESS AND LOCATION ' S ztti i} C J�1iL ' Jam= �` � X. , r7c - ----------••---••--_r-_- ---- -- ��l/ -=.C1f i�.-.-- Yom! ' 1----. ,� / - • ----- Owner's Name . `lf f� _4�----------2--� --------- --- ------ ----- Phone--------------`---=----------------- r ------------------------- Address----------------- .......... ,r Contractor's Name-----------------. �1,P ------------------------------------------------ ----------------------------------------- Phone----------------------------------- _ l Installation will serve: Residenceg Apartment House ❑j Commercial ❑ Trailer Court ❑ �Motel El Other ❑ Number of living units: Number of bedrooms __� Number of baths -1----- Lot size ._!/ ``_ `'_ _---Za_A____________________ Water Supply. Public system: ❑ Community system ❑ ' Private Depth to Water Table Character of soil f l' o a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�' Hardpan ❑ Previous Application Made: (If yes,date____________________} No New Construction: Yes ❑ No [%' , FHA/VA: Yes ❑ No ft TYPE OF INSTALLATION AND SPECIFICATIONS: '` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F� Septic Tank: Distance from nearest well________________Distance from foundation--------------------Material---___---------_____.___________-_- ------------• ..- � ,�.y No. of compartments---------- ---------------Size------- ---------------:---Liquid .depth----------- --------------Capacity----------------------- Disposal ---------- ------ P � I � / rom nearest well___ _._.Distance from foundation___---/P-------Distance to nearest lot line___________. „ al F ------------ Number of lines___._-_-�2__._--__�__._________Length of each line_ _:;:_ _-�_1__ 1� Nl g � J��" �=1_.Width of trench-----2=-�.................... i� it l 4 �- Type of filter mate rial_.-S____�_-_____:_ _Depth of filter mate ria l__�f ___________Total length-------fl 5_______________________- II Seepage Pit: Distance to nearest well---------- -----------Distance from foundation----_--------_______Qistance to nearest lot line----_---------_•^ ❑ Number of pits----------------------Lining material----------.------ -----Size: Diameter-----------------------Depth-_------------------------------- .P Cesspool: Distance from nearest well------------------Distance from foundation--------------.___..Lining material_-----.--------------------------- Size: __- __-_-.______________Size: Diameter----- ------------- Depth---- ------ - ----- - ----------Liquid Capacity--------- ------gals. - rom nearest.well _ _______ _. ___________ ---------Distance from nearest building------------------ Privy-: Distance to nearest lot line----------------------------------------------- r Remodeling and/or repairing!(describe):---------------------------------------------------------------------------------------------------- ------------ wl_ f . -----------------I----------------- ---------- ------------------------------------------------------------•------------------------ ---------------------------------------•----------------------- :----------- I hereby certify that I have prepared this application 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. �Si ned g )----------,-•--•----•--------------�'f -------------------------------------- - =----------------------- - ------------._-------- ---------- --------------(Owner and/or Contractor) ---•--------------------------------------------------------------------(Ti+le)----------------------------------••-------- -- ---- ------ (Plot plan, showing size of lot,llloca+ion of system in relation to wells, buildings, etc., can be .placed on reverse side). fT FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED B L �'J ---------- ------- �_! _ AIT _ r' V !� ' REVIEWED BY--------------------------- ---- --- ------------------------------ -- ------------------------------- '- -- --------------''. DATE---�-------- --------------- ----------------------- --- BUILDING PERMIT ISSUED---=' — .- �; •�------ ---------------------------------- Alterations and/or recommendations:---------------------------------------------------------------------- t y --------------------- -/----- ------------------I`-----------•-------------------------------------------------------------- -------------------------- . -----•--------------- -------------------------- - -R------------ ------------ ------ ------------------------------------ ------- ----- ---- -- ------------------------ FINAL INSPECTION BY:.. = --------------- Date.. ------ -------- /.J. ..{ - I, ll` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E,tlaxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California 1; Lodi,California Manteca,California Tracy,California LS 9 REVISED 8-59 3M 3-•83 F.P.CO. _ I