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FOR OFFICE USE: r, __ _____ - --------------------------- -- ---------- ---- ---•--- APPLICATION FOR SANITATION PERMIT Permit N°• (Complete in Duplicate) 6 • Qate Issued _--- This Permit Expires 1 Year From Date I4con Application is hereby made to the San Joaquin Local Health District for a permit tu�nd install the work herein described. This application is made in compliance with County Ordinance No. 549. p $- �n�0 C.F3sG� � / J ------yAn�4 OB ADDRESS AND CATIO -----//17.7x---�c. .--- -- //� • "� Owner's Name �� r 5--------- ---------------- ----------- ------------------------ Phone --------------- Address ----------------------- ----------------- Contractor's-Name--- --------- ----f- Phone-------------------- ----•--_------ --------------------------------------------- -- Installation will serve: Residerice-❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ 9_ �__ �_ Number of baths z----- Lot size -- cQe_4. •-----------------I---------- ty Y �� Water Supply: Public,system ❑ Community system ysemm$lPrivate D—@ phi to Wafter Table �--- ft. PP Y: - Character of soil to a depth of 3 feet: Sand ❑ Gfavel D-Y-Sandy.Loarrn-E3—C`Tay--L-oom-a—Glay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------------_ 1_j No ❑ New Construction: Yes O_A3e'(] FHA/VA': Yes [�.�1�10 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS ;. (No septic tank or cesspool.,permif±ed-if-public sewer.is available�ithiin 204 feet•) _ a _ t ...: Septic Tank: Distance from nearest well---�O _Distance from foundation___,/.11________ Mateiial____ r �....... ----- ri l p -� Size. f � � Liquid depth ..4/.-jl ------- e '' - Capacity 2 0 No: of com artments_____ ---------- Disposa# F' d: Distance from nearest well-_:_1_L/-__--_Distance from foundation_.__ _ O -- Dista nce to nearest lot line___ Number of lines-�-------------------------_Length of each I,ine_Z p?? $_0 __(Q_.Width of trend___-_- __`f__�!._____.-_______ • h Type of filter materia#----�_%_n_�_�_ Depth of filter material_1�!�------------Total length 3/O b---"=---------------- 1, ------------ Seepage Pit: r Distance to nearest well------------------____Distance from foundation_-________.-------.Distance to nearest lot line-------------- -._ ❑ Number of pits---- ------"Lining material-----------------------Size: Diameter-------------`---------Depth -.-{Rf----------------------- Cess ------------------ Cesspool Distance from nearest well=________"______Distance from foundation----------- -----{�3 Lining Cateacity' �_' __ _-___=_ -____gale P ❑ Size_ Diameter-- ---- -- ----- ---- --------Depth--- q P s est ___Distance from nearest building Privy: Distance from nearest well------------------ --------------- --------- g--------------------------------- ------.. ❑ -Distance to nearest lot line------------ ----------------- - -------------------•------- ---------------;--------------------------------------------------- Remodeling �- 1 - •-------------------- - Remodeling and/or repairing (describe):______________�� "-----"""" ----------------------------- --=----•-----------•----------------•------ -----------------�------------------------------- --- -------------------------------------------------------------- --------------------------------- - ----------------------------------- -------------- ----------------------:--------------- ------------------------------------------------------------------------------- I hereby certify that I have prepared this a plication and that the work will be,done in accordance with San Joaquin County ordinances, State laws, and,,r�951 and rregula ns of he San Joaquin Local Health District, a 'G {Si ned -(Owner and/or Contractor) J----------------- --- ----------- ---------- ---- - -- -------------------- . -----_ ------------------ -----:-------- -------------(rt _ Ie} �� a(Plot plan, showing size of lot, Joe io of system...in_relation to_ ,-buildings, etc.,.can be placed on reverse si e. 't FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY ------------ ,�_U DATE - — - ----------- ------------------------. REVIEWEDBY------------------------------------- -- ------------------------------- ;---------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED:----------------------------------------------------------------- ---------------------------------• DATE------------------------------------------------------------- 1. Alterations and/or recommendations:_:----------------------------------------- - ------------------------------f ------------------------------------------------------------------------------------------ ------------------- - - ---------- ----------- ' FINAL INSPECTION BY: /_ -•----- --------- Date d_ SAN JOAQUIN LOCAL HEALTH DISTRICT . 1 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street � t• Stockton,California Lodi,California i Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD. 1�