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FOR OFFICE USE: ------------------------------------------------------ - _.. "......................._-... APPLICATION FOR SANITATION PERMIT Permit No. ...1..�'U0 --------=------------------------------------- ------ f (Complete in Duplicate) -------- -.. This Permit Expires 1 Year From Date Issued Date-issued l Application is hereby made to the San'Joaquin Local Heal+h 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 LOCATION-- " ----- ---•----------------------------------------- v. Owner's Name ,e, '- ------ Phone--=------------------- ------------- Address------------------ ..._ _ Contractor's Name---/2Z2_ ,5.-- -------------•---•--------- -----.Phone--------•-------------- Installation will serve: RResidenceJ Apartment House ❑ Commercial ❑ ❑ Trailer Court ❑ Motel 0 Other Number of living units: -1----- Number of bedrooms ..• -.- Number of baths -s _. Lot size ---� ----------------------------- - =..,r,�Y , a . -._.. Water Supply: Public system ❑ TCommunity system ❑ Private j] Depth to`Water'Table'-YID ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Cla • P ❑ ❑ Y ❑ Y ❑ y ❑ Adobe f� Hardpan ❑ Previous Application Made: (If yes,dote--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes'❑ No p I 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-XA_-`-_-Distance from foundation.--ZP':...... Materiai.... ------------------"-. [�] No. of compartments-------A�--------------Size_#�"_91'r—--------Liqu'id depth--------q--------------Capacity./e;!*�_ ----- A Disposal Field: Distance from neares well-AZO Distance from foundation.../ _.-:_.-.--Distance to nearest o line...�'�._._-..----- [� Number of lines-.-.__ -Len th of each line----- " 4 9 Width of french Type of filter materia --Depth.of filter material--------9------ -'------Total length.- -- -----------_------------- I Seepage Pit: Distance f new wei_/� _-__Distance from foundation--- to nearest lot line.-7---------- k .Number of pits..'_ ---------_Lining material-llfMie--------.Size: Diameter.-_ , _"- ...-_. ---- Depth_.A 7--------------------- Cesspool:' . --..-__---- CessPool: Distance from nearest well _ isfato from foundsion----- -----•Lining material.....-------------------------------- El --.-...____------- _-.--.pSize: Dam ---- --- Dp ------ -----Liquid Capacity---- -----------------------gals. Privy: Distance from.nearest well-- ------------------------------- ."".--€}s#ante.from=nearest building Distance to nearest lo+ fine Remodeling and/or repairing (describe)-----------------=--------- ----------------------------- --------------------•__._-----------------------------.-----------------'---------------- ....--.....__......_. Y y � ........................................,..._.....__..._._-._.__-_--._.___.--...--____----_-.___._._._ . �._ ---------................._._......-..__.....-_.._.._._-_......_..- .-- ---------------------------------------_.__.-• .... - ...__-..--...._.__------------------------------------------------------------...-----._ I hereby certify that l have prepared this application and that_the w_ork will be done in accordance with San Joaquin County ordinances, State laws; and rules and regulations - of the San Joa-�-q--uin Local Health District. (Signed)----;��-- - -- 6_- -- ------------------- -- ----------•--------------, --------(Owner and/or Contractor) By:---------------------------•------------------------------------------------ ----------------------I------------------------------jif le)--------------------------------------------------- -- (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.-- ------------------- DATE--- 4_- IED BY-----------'------------------- ----------- ------------- - ------------=--- - - ------------- DATE----__: " - BUILDING PERMIT ISSUED --------------------------=-,..-;_----------- -- -•- „� - --------------------- -------------------------- Alterations and/or recommendations:';- ----------- -------- ------------------------ ------- ------------------------------•-•-•------.. ----------- -------------------------------------------------------------- FINAL INSPECTION BY: Date. .". l SAN JOAQUIN LOCAL HEALTH D)STRICT 1601 E.Hazelton Ave. 30i.'Nest Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lod,, 7-lifornia Manteca,California :,. Tracy,California ES 9 REVISED 8.59 31A 3-'63 F.P.CD.