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OR PFFICE USE: fV ---------- /_ _y____-___ h {APPLICATION FOR SANITATION PERMIT Permit No. ----------------- ------------- (Complete in Duplicate) - This Permit Expires 1 Year From Date issued ,-Date Issued f 1 � 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 incompliance with County.Ordinance No. 549. JOB ADDRESS AND LOCATION------- _ "^ , ------------ --------- ------------------------------ �-,, Owner's Name L�� -•-------- ----------- ---- ------------ Phone_ G------------------------ ......... Address ---��-----------�--------- c�-x -.�'s'1:_------- Contractor's Name-----t.1/ -- t ^ c'------------------- Phone :..7 y-66 - 9 6�© -- Installation will serve: 'Residence r2l;4 Apartment House ❑ lCommercial ❑ Trailer ,Court ❑ Motel ❑ Other ❑ Number of living units: _ _ Number of bedrooms, Number of baths ----I--- Lot size ___1__c.0�_ X__aQQ-`---.•_______________ Water Supply: Public system 9 Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E]+1 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ig Hardpan ❑ Previous Application Made: (If yes,date_________ _________I No New Construction, Yes ❑ No FHA/VA: Yes ❑ No 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---------------__Distance from foundation___________________Materiaf------------------------ ❑ �� No. of compartments-----------------------Size----------------------•---------Liquid depth-------------------------Capacity----------------------- Disposal Field: Distance from nearest well-K&ti.�. -Distance from foundation-------I_a'------Distance to nearest lot line____ __________ �] Number of lines_________ ______________________ _Length of each line-_-.-___3_,5`-'-_.-______.Width of french_.______-#47�"___-1---_-_-__. Type.of.filter materia l__,S_�__$24tc ,__:Depth-of„filter,material--------I_ "_,._ Tota l„,length----_----------_x.__._3 — Seepage Pit: Distance to nearest well__ ___Distance from foundation------X P_1-______"Distance to nearest lot line.__4__�.,._... eria Cess ool: D stance f•omits nearest ,,,,,ell-_-Linin mbistanlce5romfoundatonDiameter----.L+n3��aterial_I i t�..._ _� � � } pg ------ -------- Size, • -- -Size: Diameter----- ---�- -�---------�--•-�-Depth------- -- ----------------- -----------------Liquid Capacity:. I --F--gals. Privy: Distance.from;nearest well________________f________ _-_______--.._?_._Distance from-nearest building-?`---'- ----- -------.___, ---------- 0 __-_._._❑ Distance to ;ieare_s�tlot line----------------f --------------------------- ---- ---- f Remodeling and/or repairing (describe};:------ `�'° - `' n' ------- ff t I --------------------------------- --------- ----------------------------------------------------------i----- ------------------------------------- --------------------------- ---•----------8---- - y - Y ------------ -----------------•----------------------- ---------------- -------- ---------------_------------------------------------- b ce -----------------•---------------- ---- I hertif that-I have prepared this application and that the work be will done - rein-accordance with San Joaquin County 1T ordinances, State lawsand nd rules and:regulations of the San Joaquin Local Health District, i3 u (O ner and/or Contractor) (Signed)-_.,----- ------ -- 11�z �--------------- --- By= - ---- ---... ---------------------= = {Title)------------ ------ i = ----------- -- ------- -------- (Plot plan, showing size of lot, location`of system in r lation to wells, buildings, etc., can be,pleced on reverse side). ( P u) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' r---------------------------------------------------------------------------=- DATE----`O --&------ ----------=---------- REVIEWED BY------------`------------- f --- ------------- DATE BUILDING PERMIT PERMIT ISSUED - DATE---------------------------- Alterati ns a /or reco endations---------------- ---------- ------------------- ---------------------------------------- - -----------------•-----y, _--- ------------- --------------------- ------ ------------------------ - ---------------------------------------------- - -------- -------------- - --------------- ---------------------------------I -------- --------------------------------------------------I— •---------------------- ---------- �3 � irF .�+..as= •w�--'�-.. .sa s..vweYe,M.ra.• .'+r'.+- - -.�+.- � irYe- V 1-_ - FINAL INSPECTION BY:------- ------------�c`---- - -------------------------- Do+e--------"--- f }} SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ava. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California z Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.DD. .