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FOR OFFICES f% PPermit No. ------_ APPLICATION FOR SANITATION PERMIT � . . .. ------------------ ------------ (Complete in Duplicate) Date Issued ___-- .•-----�e-,'�-- ---------------- This Permit Expires 1 Year From Date Issued 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 in compliance with County Ordinance No. 549. JOB ADDRESS AN LOCATION_________ - D__Q---- ---. - � 7 Owner's N AUL+ j `' p 1- Phone-- -`-••--- ------------ l % Address --- Phone.•-----------•--- Y)-- � ------- ------- Contractor's Name--------- _ Y)--� Installation will serve: Residence11�partment House ❑zCommercial ❑ Vail r,�Court ❑ Motel ❑ Other ❑ Number of living units: ___f___ tuber of bedrooms _G_ Number of baths --- size ------ - ---- -- -- --••-------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _� . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ dobe �rclpan ❑ Previous Application Made: If es,date_-_._..--_-_-.----) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ Prev pp l Y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V;nl�j Distance from nearest well--7°_---Distance from founda1ion___/6_!-------Material_________________._____-.--________.._._______- No. of compartments--------------------------Size--------------------------------Liquid depth-- ----------------------Capacity-----------/- ---/-- Distance from nearest well--> 1.._.-Distance from foundation__ 0.___ .Distance to nearest lot line--- P t Number of lines___________________ ________ _ ___Length of each -------------Width of trench--------.._._____..__- . J-� D nn e- --------------- Type of filter material , a_a, tC -Depth of filter material length____________ _ _ Seepage Pit: Distance to nearest well---Y hU �-_--_Distance from foundation---..'�.t� i�sIfi�n � nearest lot line.___ __---. Number of pits--------/-----------Lining material__��.____ _.__.Size: Diameter------ 7-&----_Depth------ /.__ ____-__-_-._ Cesspool: Distance from nearest well-----------------Distance from i6undation--------------------Lining material__.____.-__...___________._______._. ❑ Size: Diameter------------------------------------ Depth------ -------------------------- -----------------Liquid Capacity_--------------------------gals .- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line--------- ------------- ----------------------------•------ ---------------------------------- ---------------------- ------- 1 Remodeling and/or repairing (describe)--------------- - -- -- ----- -- -OAA --- ------ -- —�--------------- •--•-------------------------------•---------- t✓ --------------- T----------------------------- ------ ' ._.... -------------------------------------------------- ---------•------------------------------------------------------------------------------------------------------------------------------------------------ -------------- I here certify that I have prepared this application and that the work will be one in accordance with San Joaquin County ordinances, t e law and rules nd regulat'Wnsoff the San oaq in Health Di cf. ac tfoalls, [Signed} [��TContr tor) --------------- - Title --------------(Plot plan, showing size of lot, location of system in relatiobuildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �y APPLICATION ACCEPTED BY------ --------------------------------------------- DATE------.,!__'r__g-4-.3----•------------------. REVIEWEDBY----------------------------------------------- ---------- - --------------------- DATE----- ----------- --------- ---- - DAT - BUILDING PERMIT ISSUED---------------- --/---- - - - - - --------------------- -:- ------------ ---z;---,----- - ---- -- --------- ------------ - - Alterations and/or recommendations. __-_J - -----------------•-----•-------• ------------------- -------- --- --------------------- ---/--------•----- ----- ----- ------- _ � - - ... -------- - - . �.. ----------------- � - -------- --- ----------- f ---------------- FINAL INSPECTION BY:. - ---- -- ------ ----- -- ------------ Date_--- - 1 �---- --------------------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Es 9 REVISED 9.59 3M 3-'63 F.P.CD.