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r_UKUN-rc..E USE -------------- ---- •-0- f -----------------_-------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 166...5 -------------------•- --------------------------------- (Complete in Duplicate) ----------------------------------------------------------- This Permit Expires f Year From Date Issued Date Issued 0_70_64 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�inRcompliance with County Ordinance No. 549. l 3/ --o(.Q—ob - OB ADDRESS AND LOCATION----- Owner's Name---- F. Phone. P .i - � _.,s- '3 Address 1 .. U ' Contractor's` Name---------- --------------------- Phone.................................... F Installation will-serve: ResidenceA Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑- Other ❑ Number of living units: -------- Number of bedrooms AR!_ Number of baths /----- Lot size __.-��f��...................................... Water Supply: Public system ❑ Community system ❑ Private Vj Depth to Water Table ft. ��rr P ❑ ❑ Y ❑ Y ❑ Y ❑ A64Zc an 0,D Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adob 'Har Previous Application Made: (if yes,dote------_A/A2-----) No ❑ New Construction: Yes US,No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool'permitted if public sewer is available within 200 feet.)It- Q Septi Tank: Distance from nearest well____?.-gA----Distance from foundation..._.�'� ��op �v�]] ----._....__.Material----�.-- ....... j, No. of compartments:.___ ---------------Size____ _+ " -�_ Liquid depth �.-c 1 74 •- - - - 9 P� ---------------Capacify_,X. - Dispos Field: Distance from nearest'well-_sJZ1_a_____Distance from foundation..._.A41__.......Distance to nearest lot line.,...._. Number of lines ��_:_:_"`"�_�- Lerigth`'of each line-____4r^J__-____.___a;-Width of trench-_____6....0 3 Type of filter material. '- -Depth of'filter material._--______ Total length..._____4"��C?.`p____________________ (` .,. �/. S epage Pit: Distance to nearest well-____________________Distance from foundation........------------Distance to nearest lot line................. ❑ Number of pits-----•----------------Liningterial-----}----------------Size: Diameter__--..-----------------Depth----------------------•---------- t Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material------- :___-______-.---.__--_----.•- ❑ Size: Diameter-_',------------------------ -------iDepth---------•-----------------#----------------------- tLiquid Capacity_...---_4----;y•---------.gals. � Privy: Distance from nearest well----------- --------------------------------------Distance from nearest building______-.--4______----_____---.-.-------- ❑ Distance to nearest lot line ------------• ------------•-------------•---------------------••----------•--------•----•------------ Remodeling and/or repairing (describe):------------------------------------------------------------- --------•-•--------•---------•---•-- --••------•••---------• ------- . a•` ------------------------_----------------------------------------------------------------------------------.----------------------------------------------------------------....................-._.--------------------------- I hereby certify that I have,prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of +he San Joaquin Local Health District. (Signed)--------------------- -------------------------•-•-------------.-------------•---------------- --------------------------------------------------- • ---(Owner and/or Contractor] By:-------------------...................•.................--------------------------------------------------- ---- ----------(Title)------•-•------------•- ••--------------- - -- --=---------- (Plot.plan, showing size of lot, location of system in�elefion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY----------------------------------- -------- ---------------------------- DATE-......... f •• � 6 ' REVIEWEDBY_----------------------------------------- ------ --- ----------•-----------------------•--------------- DATE------------- 8UILDING PERMIT ISSUED_----------------=---------••--------------------------------------------------------------------- DATE...... A ra+ions and/or recommend'ations:------------------------------ ----- •--------------------------------------------------------------------------------------------------------------------------------------------...-•----------------=_.--•--.....__ � FINAL INSPECTION BY------------------------ ----------- / ---------- Date__ -/-_-- - --- -� g SAN JOAQUIN LOCAL HEALTH DISTRICT 30 South American Street 300 West Oak Street 124 Sycamore Street 205 Wert 9th Street ' Stockton,California Locil,California Manteca,California Tracy,California Es 9 REVISED a•89 8M 6-61 ArLA9 - �r� ff