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F R OFFICE USE; - ---- ---------- ---- /l. APPLICATION FOR SANITATION PERMIT Permit No. -b-- - . -- ------------ -------------------------- ----- -------------- (Complete in Duplicate), ------------- --------------.-------------- --------------- ;This Permit Expires 1 Year 'From Date Issued sued, Application is hereby made to.the San-jJoaquin Local Health District for a perrriit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.....S3A R----------C2---- -Vir 1115�--------------------------------------------------- •----- -----------------•--------- ___.- Owner's Name--- nS�_ ------------------------------ ------•--•------�-�--��.�--�----- - ----------------------------I------- Phone----•--- - - -- Address----- ------------------ ------:S.ok-"ryE-)-------------------------------•------------------------------------------•-••----------------------------•--•------------ -----------.--.------- Contractor's Name . ` $ NC ------------- Phone. _�x__`_ !j Installation will serve: Residence 5e Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [:1 Other ❑ Number of living units: __ ___: Number of bedrooms _.fir Number of baths ---I... Lot size ---`$'__ ._._X-_R"o-_____________________------- Water Supply: Public..system 10 Community system ❑ Private l] Depth to Water Table -W. ft. ` > s Character of soil to a depth of 3 feet: Sand I❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe D' Hardpan ❑ Previous Application Made: (If yes,date........0_-,--.___._J No' New Construction: Yes E] No FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS- ` (No septic tank or cesspool permitted .if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------_----..--._--. ❑ � � No. of compartments_________________ --------Size-----=•----------------- ---Liquid deoll--------------------------Capacity---------------------- Disposal Fiel : Distance from nearest well--es�Q-Distance from foundation-----1.0-- ------Distance to nearest lot line___ ------- Number of lines---I-------1----------------------Length of each line-------------1.0_`..._.__.Width of trench------------;_ -_-_-_------ . Type of filter materials5_,-J6mk -Depth of,filter material----------1 --Total length---------------1__r'__'-___----__-_--_--- Seepage P, Distance to nearestwell_ �s- ---:Distance from foundation-__--t-O__'_-----.Distance to nearest lot iine-_L _�--_- - N umber of pits--------�--------------Lining mater+afl$d`i,.�s -�C=..Size: Diameter------;'3�- --------Depth-----------� ------------- r Cesspool: Distance from nearest-well---- --Distance from`foundation' ._.______-Lining material__-------------------__.:_____ __--. Size: Diameter-J. � � l - --------------- --------------Depth - = -----Liquid Capacity -----.----- as. J Privy: Distance from nearest weli__ __________________-_________--._ -----_----Distance from nearest building_______--_---.-----_----___________----. ? ❑ -t -- Distance to nearest lot line--------------;--' -'-----------=-- ----------...---------------•-44•------------------'------ -- - ---------------------------------- - , Remodeling and/or repairing (clescri 'e):-------- __ --_-- l�.1.__-. >- -- --:____ ISS_7-4 i- -------------------------------------------------- -------- --------------------------- ---- .. z' i? I c �`' t t _ ---- ---------------•-••-•----------------------------------------- --------------------------------------------------------------------------------- -------- ----------------------------------------------- .. -------------------------------------------------------=------------------------------ ------------------,----.------- =--•-----•------------------------------------------------------------------------ -----------------------------------------____________i________________-__----_____----________---___---------_-____.-__________________,__. ____.____________________________._---_-__.______________. ___..._... ---------- 1 hereby certify that I have prepared tis application and-that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and't:egulations of the San,Joaquin Local Health District. } Cc- 't •� ------------=------ --------------------•--------------- --------------(Owner and/or Contractor. (Signed)---- u �Y - --- (Title}_, ------------------ (Plot plan_, showing size of lot, location of system in relation to wells,-buildings, etc., can be placed on reverse side). lF It r : c" l , .. } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- L`-e-.-- s' '------------------------------------- --------•------------- DATE----- '?cS-r -----•------------------- REVIEWEDBY-------- -------------------------- ------ ----------------------------------------------:------- ------------------- •� DATE BUILDYING PERMIT ISSUED--------------- ----------------- - DATE - { } - - Al+ --------- ----- } rtions and orrecommen f 4 ; i ------------- ------------------ ---------------------------------- -----------=--------------------1------- -�;- -_-------- ----- ► ,. ; ------------------------' ----------=-- -----•------ -' - -------------------------------------------------- t f-------------------------------------------- 7 ,/J Date- ----- ` -- �" ----------------------- FINAL INSPECTION BY ----- �-��------�--------------------- ------ n� k jr s i USAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. J 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REV15ED 8-59 3M 3-'63 F.P.CC. {