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FOR OFFICE USE. ---------------------------- ------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No_/ _---------- ------------- -- - . .- --------------------------------- (Complete in Duplicate) D-ate-Issued ------------------------------------- ------------- This Permit Expires I 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 applicafiori is made in compliance with County Ordinance No. 549. JOB ADDRESS AN LOC ---�_.e_42 --------- - ----- JION " 0�,4, I Owner's Name---I--------63 �------------ ----------------I-------------41_1��_ - --------------------- Phone------------------------------------ - 1�4 ........... ----- ------------ -------- -------- ---•-------------------------------------------- Address---&-------- Ica ------ -------- Phone-----------------------------------tj\ -- -- --- ------------- Contractor's Name------- -------I -- --------------- Installation will serve: Residence 911*'Ap- rt'ent ose [] Commercial E]- Trailer Court El Motel El Other 0 tNumber of living units: _/---- Number of bedrooms __S_ Number of baths ----1- Lot size --------------------------------- ------------------------ Water Supply: Public'system El Community system El Private 2-_'Depth to Water Table ------- ft. 7 - 'Character of soil fo a depth of 3 feet: Sand [-] Gravel ❑ S y Loam 0 Clay Loam E�No Klay E] Adobe F] Hardpan C] Previous Application Made: [if yes,date-.- ------------) No EK New Construction. Yes E] FHA/VA: Yes E] No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic,tank or cesspool permitted if public sewer is available ; _-A i4hin.200 feet.)-. ........... Septic Tdn k Distance from nearest well----%Y-6-----Distance frpm fondcation-_149---------Mate i a-------------CapacityJ I------------------------------------------------- t uI - --- No. of compartments--------7-`----- ----Size- Y5�lquid ddpth--- - DispjField: I Distance from nearest well... ......Distance from foundation------14�_`_.__Disfance to nearest lot line_-5....... 1 . Number of lines----------------/------------I— Length of each line------- ------Width of french__-0--�--- ---------------- Type of filter material- -.144do/7-Depth of filter material--------/,P f....____Total length________aQ--------------------- f Alv_ gun Seepa Pit: Distance to nearest well______/jOA -- -- ---Distance from 7f dation----�__6----------Distance to nearest lot line-S ------- Number of its___0?-------------Lining material_.e444W_ Size: Diameter---- Dept OO --------------- Cess" I Distance from nearest well-----------------Distance from foundation___._._.___.___---- Lining material___._____.._-__-.--_________.______- FSize: Diameter-------------------------- -----------De pth----------------------------------------- - --------Liquid Capacity- - ------------------------ga El Privy-. Distance from nearest well------ ------------------- ----------------------Distance from nearest building___-.---------.________________._____..__. ' ❑ Distance uilding------------------------------------------ Distanceto nearest lot line-- --- ---------- ----------- - -----------------------------_------- ------------------------------------------------------------------ R6mc;deling and/or repairing (describe):_.--_____-- ------------------------------------------------------------------------------------ ------------------------- ------------------ -------------*--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- I---------- ----------------------------------------------------- ---------------------------------------------------------------------------------M---------------------------------------- - ---- --------- --------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordin-'ances, SfW]aws, and rules ndd regulations-of4he-.San.J n1ocal Health District. 0 ----K:Cze�_ ed) ---- ---- ------ --- - --- ---- -- ---------- ---- ----------- Contract (Sign ------ --- ---- -- . ...... - --------- -------- By:--- -- -- ----- - ------ ------------- ------ ----------------------------(Title)------------------------- ------------------ (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-----Z:�4�� -=--------------- --- ------------------------------ DATE-_'-7--� -- ------ --------------------- REVIEWED BY----------------1------------------------------------------------ --------------------- -- - ------ --------------- DATE-----------------------------------__-------------------- BUILDINGPERMIT ISSUED------------------- ------------ ----------------------------- -----------------------------I--- DA-TE------------------------------------------------------------- Alterationsand/or recommendations:---------------'-------------------------- ---------`'•---------------------------------------- ---------------------------------------------------------- --------------------------------------------------------------- - ------------------------ ----i-----------I--------------------------- ------------------------------------------------------------------------------ ----------I---------------------------------------------------- ---------------------- --- ------------- --------------------------------------------------------------------------------------------------------- ---------------- ------------------------ ---\ I -------------I.,------------------- -------- ----------------------------------------- ----------------------------------- --- - ----------------------------- ---------------------- ---------- ----------------------- ----------_----------------- --------_--------------- ---------------------------- -------------------------------------- ----------------------- ................ -------------------- FINAL INSPECTION ------ Date-_ ....16 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Are. 300 West Oak Street 124 Sycamore Street 705 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CD.