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r FfDR OFFICE USE; �3----------./r----1&_9---- -- --- -1-TA.--.__.___ _ ---- APPLICATION FOR SANITATION PERMIT Permit No. .. ..-J'3 •� ------------------------------------------------ -------- (Complete in Duplicate) 9 5 This Permit Expires 1 Year From Date Issued Date Issued `__L_____ __------ Application is hereby made to the San Joaquin Local Health District for a permit to construct andinsFall the work herein described. This application is made in compliance with County Ordinance No. 549. ADDRESS D°LOCATION.--- tv Owner's me- --------`----- --------------- ------ -------------------------- --------------• -------- ------- - --------------------- Phon ' Address + -•--- r� Contractor's Name--- A- {--}- -• iCJ 's--------------•------ •---• --. Phone---t4.v-- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __Number of bedrooms _Ch_- Number of ths --.YiLot size Water Supply: Public'system n Community system ❑ Priva+e Depth to Water Table&6ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam p Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,date------------_------) No ❑ New Construction: Yes ❑ NQ-W- FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: .� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 0 ��^ � Q Septic Tank: Distance from nearest well-1-0 _ -_Distance fro faun tipn_..J.V5-____.Mate�ia�'2 e 8__-.--/ ------__•-- No. of compartments-..__ _._._ _ _ ____ /C ---"_ _'_ r 7� 7 .S Liquid depth -----------Capacity-11- oto �i R ' Disposal Field: Distance from nearest well_. __ _Distance from foundation----t-.____.Distance to nearest lot lin Number of lines_________ --- Length of each line-.------_l___O-_�f----Width of trench_.__ Type of filter material____- r!w Depth of filter material____,_ _- _-_-__Total length______________________ Seepage Pit: Distance to nearest well_- _1-0-70 foundation_______! _.Dist n�� to nearest lot line...fG Number of pits-----I----------_....Lining material_IL . .__ --------Size: Diameter.�_� �j"'- --,Depth--- -- -- ----- ------- �. Cesspool: Distance from nearest well-----------------Distance fro foundation-----.--------------Lining material__._____________________.--______.._. �~ p --- --------Liquid Capacity----------------------- ---gals. � y Privy: Distance froIJ Size: m nearest well_________________©�._th____._______--------Distance from nearest building------------____________._______________-, ❑ Distance to nearest lot line-------- ---------------i Remodeling and/or repairing (describ � --=---•----- - ----- -- ---------------•-••----------------------- = ------------------------------------------- �M --------------------------------------------------------- -------------------------------------------------•--------------=-- -----'------------------------------------------------- _---------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I J ordinance&S11e s, an rule nd regula ions o the San Joaquin oval Health strict. '2 (Signe( = - ---- --k��- (�or Contrac+or) by:------------ ---------------• . -- ----- r _ ifle)-------------------------------- -- A (Plot plan, stowing size of lot, location of system in relati to wells, buildings, +c., can be placed on reverse side). h y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - - ------------------ - S-fP3 --------------- DATE 9 - -- - - ----------------------------- r REVIEWEDBY------- ---------------- --------------------------------- --------------=------------------------------------------- DATE------------------------- BUILDING PERMIT ISSUED--------------------------------------- -------------------- ------- -- ------------------------ -------------------- DATE---------------------- Alterations and/or recommendations:-___ -{a -------_ �'� y� qn - ,eq� C{ FINAL INSPECTION BY:----- ��_� 4--------------------------- Date----- -. 7-4_-5 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haaeltan Ave. 300 West Oak Street 124 Sycamore Street �,t,_" 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3•'63 F.MCD.