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FOR�IC�SE: � X41 -- - -- ------- ------ -- APPLICATION FOR SANITATION PERMIT Permit Na_ ____Z__________________ —------------ -L------------ (Complete- (Complete in Duplicate) R/ 1 - r Date Issued ______ _5_l-- 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 wi County Ordinance No. 549. J08ADDRESS ArCATION � - �-- `--` � ----------------- ------:-- --------------Owner's Name--- /_?'�-------- ------ --x_, 1 ---------- -------------------------------------- Phone----------------------- ...__-... -- - ----- ----------- Address '�.S'� - - •-•-----•------------------: ------------- y�, �d Confiractor's Name /�' -C'� ----------- Phone.. fir. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ #�. I Number of living units: __. __ Number of bedrooms : Number of baths 2 Lot size _J,l 'a.._x _ �..:�_________________ Water Supply: Public system,❑ Community em Priva.fii ❑ depth to•Water Table4,5,_ ft. :N Character of soil to a depth of 3 feet: Sand ❑f 'Gravel ❑ Sa Loam ❑ Clay Loam Clay ❑ Adob Hardpan ❑ Previous Application Made: (If yes,date.......... ... ....], No NewConstruction: Yes �o ❑ FHA/VA: Yes �No El TYPE OF INSTALLATION AND SPECIFICATIONS'. (No septic tank or cesspool permitted if public.-sewer is_available wi+hin 200 feet.) Septic T Distance from nearest well,-' Distance from.oundation _��__ Material 6_70 No. of com artments_.. ---------Size-- qp ---------------Capacity_._-, ------------ It t p ,-�------ .ate--�--�--L. uid de t�,- - Disposal eld: Distance from nearest we€i-_____.Distance from foundation__,�a__ _------Distance to nearest lot line__ S5 __'/.... Number of lines------2r-._..- - ---------Length of each lin U� ,.`�1 __..-Width of #rench.,�&lL... _____________ ,,.Type of filter material___�1� � De.pth}ffilter �mterial___44--- r Total length----- :.�------------------- __ See pag it: Distance to nearest well . ___ Distance from foundation___/_d________._. Distance to`n"earest lot line____, _._.. Number of pits.....-.-_^Lining material_Y0C._X'.A .Size: Diameter,.__._._..___. p ��____________________ • _ De tn_ -_ 1 Cesspool: Distance from nearet w llA____.___6stance from fou da+ions -O�Li�nfng material_._...._. .__ --------------- s❑ Size: Diameter_-__. � ------ Depjh------------------------------------------ --Liquid Capacity------------:7 ' ---- gals Privy: :. Distance from.Weare ft well _ Distance f o nearest building __________ _ _ --------------------- --- ElDistance to nearesf of line------------- ------------------------:-+--------:------------ Remodeling and/or repairing (describe t ,� . w � � � - i- -----• ------------------ " ----------------------------- - --------------- ----- • --------------�a- i .�.A -------------------------------------------------- ----------------�- --- - ttt r - ------------------ --------r-------------------------•------------------- - I hereby certify ha+ I have prepared this application and +ha+ the work will be done in accordance with San Joaquin County ordinances, State and rules an ulations of the San Joaquin Local Health,District. ' I # . �3_"`� ._ --------------- By: �.4__ . -'� Owner and/or ,Contractor .(Signed)- - { / ) BY• etc. can bi ) •. (Title (Plat plan, showing size of lot, location of,system in relafionK4 wells, ie placed on reverse side). FrO06EPARTMENT E ONLY I � =' APPLICATION ACCEPTED Y -- ----- --- --- --- ------- QATE 1 ------------------------ --- ----------- - - ----------- ---- ----- ---- 'DATE------------ Z1--------- - -------- ---------------------- BUILD NG PERMIT ISSUED- • .•------ .�: ---. � ------`--Y-y D-Ar-'0,;---------- T ---- ---- ------- ---------- r Alterations and/or recommendations:----- ----- �----- --- --� ------------ -- - --- _ ��.��_ Ir -- _ / "��- - - ------ - - !.�s.f_. ----------------e- _ ------ ----------------- -------------------------------- -* --------------------------------- -----------------------------:-- ---- ---------------- - ---- ------- ------_---- -------------- •-----•--- ------•--------------------------------- ---- --------------- - ----------------------------- -1NAL INSPECTION BY: ---------------------- SAN ----;=---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockfon,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 31A 0-'63 F.P.Co. f