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l OIj.OFFICE USE: I1 r/� Ctf --1/- APPLICATION FOR SANITATION PERMIT Permit No, _-,1___ _____ ________ :-.-- . - (Complete in Duplicate) ... _.._-_._._-_ This Permit Expires 1 Year From Date Issued Date Issued ___7...6_y Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal work herein described. This application is made in compliance with County Ordinance No. 549- JOB ADDRESS AND LOCATION--- -•------------------------------------------ •-- ----- _-------- -•--------•------- Owner s Name------- .__ Phone-----•----------------I-•------- Address------------ ... ..._• '--------------------------- �' �—c� /�J/v 1 PhoneA= r �? b Contractors Name.------ 1 rL:. ... /�__....---••-•-- 1---- _------• I' InstailiGn will serve:-,Residence ❑�_ Apartment House ❑ Commercial [2--Trailer Court ❑Motel:L] Othrar ❑ Number of living units: ...... Number of bedrooms ________ Number of f aths __-_ .__ Lot size ____ __1.__ F____ ._._ --------------- Water Supply: Public system Community system El Private E] Depth to Water Table __-.,.-- ft.V [ Character of soil to a depth of 3 feet:. Sand ❑ Gravel ❑ Sandy Loa' Clay Loam �' Clay ❑ Adobe ❑ ` Hardpan ❑ Previous Application Made: (If yes,date------------- ------I No ❑ New Con'truction: Yes Vl--No ❑ FHA/VA: Yes ❑ No�� TYPE OFJINSTALLATIOWAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j I / Septic an k: Distance from nearest well _'n��_.-._ Istance from foundation .... 1-.-.0......_...` - _(� :.:............_.-_.___ I �No."'of.compartments_-_...._.... `-...-..Size--. a�!rX_�J ..Liquid depth....... ' Disposal field: Distance from nearest well..%s �ence from foundati n__r.-..:_..._.plstance to nearest lot line ,----- �__ 4 Number of lines-f__.. _.____- k.---:___-__ Length ofteach line_._7 _,?sa�_. _ -.Width of trench.-.'.:. �____________________ W �I Type or filter malterial____ .P.__ErGZ/._Dep+h of filter material _--le '/ ------- ,Total' f r Seepage .Pit- Distance to nearest well y'� istance from foundation --- /1?•____-_.Distance to nearest lotlin ._..-_____-- iNumber of pits_1..._'Z -__.-Lining material_Z.1 �.°.Size: Diameter. _�.�G..._- p 1 1 , Cesspool: i Dis`ance f;om nearest well.__..... -.-.__Distance from foundation --------------------- Lining material .............................. ❑ t Size: Diameter-..!--------------------- I ----------Depth----------------------r----------------------------. Liquid Capacity_ ---- ...................... gals. � Privy: Distance from noerest well_____ _________...__. _-_.. _--:I}istance.from nearest building._.._...._..v............. .__:_..--_... ❑ ------------- Distance to nearest fo+.I:ne .. f......`--........_.__!. .............. --------------------- '--------------------------------------.----- ---------- - - _.....__ .----------- Remodeling and/or ra airin escn be:_..__t �G Gt f 4 T -`-`-� -...... --------------------- ....... ----------------------------------------- c,1 .......... ------------f----------------------------------------------- ------------------------------------.---•----------=-----------_--------__------_--��.— .__._..--- - _ ----- 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 r gulations of the San Joaquin Local Health District. (Signed)_ ;1 '�% .est -----------.........................._-----~:._.._(Owner and/or Contractor) By: -------------------------------------------------- --•••---------•--•--• "-(Title)----------- .............................. ----•-- 1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed•on reverse side). l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--•---- ------------------------------------- DATE------ �'-J�.................. REVIEWED BY. ............................. ........... DATE .................................. ..... _ BUILDING PERMIT ISSUED -- -----------•—•--------- r-- DATE -- - Alterations and/or recom endations:..._.._. ,---"'t a. r �" ` �'----------- 1 ......._..._ •- -- - ----- --•---------------------- --- --•-..._ . ............... --- - ......._.......................... _............ -----------....•----•--••----- - --------------------------------------------------•---••--•}•------- ..-------- •---._.__..-•----•--------••--------••----••---...._._.....-•• ----- ---------- ------------ ........... ............ Ole FINAL INSPECTION BY%. ..-___ ------------------ �/ �' '• -� - Date----- - / �............. .............. SAN JOAQUIN;LOCAL HEALTH DISTRICT 1601 E. Ffa:elion Ave. 300 West Oak Street ; 121 Sycamore Str eta 205 West 9th street Stockton, California ( Lodi, California Manteca, California Tracy, California ` QS 9 REVISED 8-59 8M 3-'63 F.P.0 D. � -.