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FOROFFICE USE: 1 ----`- ---------- ----------- _ ------- APPLICATION FOR SANITATION PERMIT Per No, _115_ .. _ [Complete in Duplicate) - 7 -------------------------- -------- --- This Permit Expires 1 Year From Date Issued Date Issued .._ Application is hereby made to the San Joaquin Local Health District for a permit to construct d nstall the wQr herein described. This application'is made in compliance'with County Ordinance_No.,549. LJ� 1,�fD�N b� f r0'�?%_-,7A.� Dui, J G .•�� J B ADDRESS A LOCATION______-c _ �1f �_==_ _ ------------------ - - - Owner's Nam . . _V------•---- `- Phone z `` --------------------------------------------------------------- Phone - _.7t --+----------- •----••--•---•---- i -----•---- Contractor's Name-----'--------- - P f -- --------- _-�____ ___---- --•--- Phone-----•----••------------ - Installation will serve: Residence 2111 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: ___ Number of bedrooms _._l__ Number baths --k- 'Lot. size ---'--I _-- ------------------------------------ FWater Supply: Public system [ICommunity system❑ Private epth to Water Table �_ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2rHardpan ❑� f Previous Application Made: {If yes date___.--_-.-_.__ } No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑� �i TYPE:OF INSTALLATION AND SPECIFICATIONS: 4 (^l� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I No. of compartments 7� Sizer /--------_--------' Li {d Matedial 't Septic ank: Distance from neatest well__..__ -- 0"'`Distance�fromf�u�ndatioquid depth____________________..___Capacity__��lj� �- Dispos Fceld: Distance from nearest well-- Q -Distance from foundation ib r.___..-..Distance to nearest lot line.-____ Number of lines__------_____ Length of each line------ i�_-e----_--__.Width of trench..____ Type of filter material __.___Depth of filter,material__-_-/�_i�__._____Total length____ ._ -__:_-__- R - _ Seepa Pit: Distance to nearest well'\_. ,00 --_-Distance fr undation ___-Z�..._ . Dist' e to nearest lot S___.�_._`..s • s Number of pits,-------f ` ._'Lining materia _.Size: Diameter_ __ ---- -Depth____._.---__________._ 3 t r,T #, C Cesspool: Distance fi-om newest well_________-_-'Distance-from foundation.............:......Lining material___-------.__-._'___ ❑ Size: Diameter----- # { ; " - N' �.-. ---------- --Liq�id Capacity ---gals. =-Depth-------------------- -------- = Privy: Distance from neares well___-__j_________ ___ -----_------------------_._Distance from nearest.building--____--_-------------------------------- ❑ Distance to nearest lot line_____________________ -? ` � I } , Remodeling acrd-/of re�T ) --------•--- --------------------------------------------- --------- V I - ------------- ----------- ---------------------•----- --------•------'•---•-------------------------•------------------------------------ ----------------------------•--------„_ ------------ h ; I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count, ordinances, State laws, apdlrles and regulations of the San Joaquin Local Health District. (Signed) --- ------------------ ---------------------- --- - 4d/or Contractorl X , 8Y ----------------- ---- = {Titlel ------- €------- - -- (Plot plan, showing size of lot, location of system in relation to" wells, buildings, etc., can be placed on reverse side). , i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ I4 ---------------------------------------------------------- 'DATE--- REVIEWED ATE_.REVIEWED BY-------------- ----__-------------------- ---------:-- ---------------------------------------------- DATE -BUILDING PERMIT ISSUED---__-------------------------------------------------- ---------------------------------------•---- DATE_---------------- l -------------- Alterations and/or recommendations:------------- ------------------- ------------------------------•------------ --------------------------------------i------------- --------------------------------- -------•---------- -------------------------- ---------------------------------------- ----------- € - - ----------------------------------- FINAL INSPECTION BY: ---- --------- Date--- SAN ate SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nazellon Ave. 300 West Oak Street 3 24 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED S-59 3M 3••63 F.P.CD. - A f