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• FOR OFFICE USE: / / l ------------------1` Perini# No. 7 7r APPLICATION FOR SANITATION PERMIT - ----------------- -- _. . - (Complete in Duplicate) Da#e Issued -- ------ -_ _ __.#_.___--.-_ This Permit Expires 1 Year From Date Issued Application is hereby made to-the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with.County Ordinance No. 549. -4 rye, ,� ,. JOB ADDRESS AND OCATION_-_ .r 3`�`�9 -- // � �`- h Gl , II -P one - Owner's Name. ---� 1 Q,ae. --------- ---------- STT Address._ s] - �'J� •------••-------------- -•------•-------------------•-•------------------- ----- --------------------- ------- Contractor's Name--- -u!. a Pone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ `��; i117- -- Number.of living units: __l--- Number of bedrooms -3_-- Number of.baths _- --__ Lot size _1_ - -- Water Supply: Public.system Community system ❑ Private ❑ Depth to Water Table I f. Adobe Hardpan Character of soil.to a depth of 3 feet: � Sand ❑ Gravel ❑ 5a day Loam ❑ Clay Loam ❑ 'Clay ❑ ❑ t Previous Application Made: (if yes,date.__..-- 1 No New Construction:tYeso ❑ FHA/VA: Yes ❑ No PP t. , . ;- T TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well-----------------Distance from foundation___/_O_.----- ----. No. of compartments___------------- --Size--3-DC- -`- -=- Liquid depth---- 9------------------CapaatY-- oo --------- P I Disposal Field: Distance from. nearest well.-:-`- -----Distance from foundation- a`_� .----Distance to nearest lot line.- -!-�---_- Number of lines---- ------------Length of eachfline-,. -- -_`- --Width of trench.-----------------' W - • Depth'. filter:material----IK-7--#-----Total. length-`----1 -____-----•------- Type of filter material---eezn �- p - *dation Seepag Pit: Distance to nearest well .--------Distance from foundation__ .---.._-_-.Distance to nearest-lot line---.-_____- Number of pifs-_-'_�- Lining material-------�� -Size: Diameter---_.'. G- _____Depth__ -_---------"--"- Cesspool: Distance from nearest well---..-----__---_Distance from {oundation:'.�:�":�-----=Cinmg-material-_._-- ------------------------ ,.� gals. Siie: Diameter------- ------ ----------------------Depth.----------------- --- -------- ----------- Liquid Capacity - 9 I Privy: < Distance from nearest weil--------------------------------- -- Distance from. nearest.building---------------------------- ❑ Distance to nearest lot line--------- ------ ------------ t .. I3 ----------------------------- -------- Remodeling and/or repairing (descr'sbe):---------.:------------------------------- =---------•--------_---.------------------------------- ----------------------------------- ------------- ------------------------- ------------•-----••-----•-----••------•-----------•------------------------------------------------------------• ---- ! ----- --'---------------------------- - , - •- ------------------ = - ==,. �`--------=-------------- I hereby certify that I have prepared this application and that the work will be done in accordance wi#h San Joaquin County ordinances, State laws and. rules,and regulations of the Sa oaquin Local Health'District. n t t -- -------------=--------- - --------------------. (O'vnet con t ) (Signed)-----------•-- - -- ------------ ------------------------------------------------ = - ----------- Titl ( e}-- (Plot plan, showing size of lot, location of..system in relation..to wells,.buildings, etc., can be placed on reverse side). q. 3 FOR DEPARTMENT USE ONLY + [E� k DATE t ----- APPLICATION ACCEPTED BY-- -------------- --------- -- -- ----------------------------- - - - ------------- ---- - ----------------- CE� ,� �° _ - � DATE------ ------------------------------------ ---- REVIEWED BY------------------------------------------ ------------- - BUILDING PERMIT ISSUED---'-----''-f------------------ ------ Alterations and/or recommendations:-_�,j ---- -- �- - •-------- - --------------- I----- ----------- ----•------------------------------------------••---------`--------`--------------•--- _ ------------------------------------------------------ , Date Q ' '"."-------------------------- --------------- FINAL INSPECTION BY:-.---- -f/ --------------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 P REVISEd 0-59 3M 3-'63 F.P.r.0. F