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/ 0 OFFICE USE- ---------- Y --------------------------------------- -----a_ -3o APPLICATION FOR SANITATION PERMIT Permit No. __....._..._..__7.._. --- ------ ---- --------------------------------------- (Complete in Duplicate) Date Issued L_ -`4--6.3 .--- --------------------- 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 LOCATION - r3 Owner's Name--- -------------- Phone.------------------•-_----------- J -• - do Address-----------------°2`r ------------- "'""� Contractor's Name----- .� 7S Phone------_------ -------------------------------------------------------------------------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___L___ Number of bedrooms __z- Number of baths ___1___ Lot size ___//—ZO I a�_______________________.____________ Water Supply: Public system EK—Community ❑ E] li ommunity system Private Depth to Water Table . p ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe n----Hardpan ❑ Previous Application Made: (If yes,date--------------------) No M--'-New Construction: Yes gr—No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septicwell �k: Distance from nearest well_______._______Distance from foundation_�0__`____._.__.Material__1- -------- No. of compartments-------' .------------�Sixe__-.-��-��-�_-._--Liquid depth---=�-�-----------------Capacity----�a -'_�. Disposal Field: Distance from nearest well___- ___--_-_Distance from foundation___10___-_____.Distance to nearest lot line__6------_____ ®� Number of lines------L---------------------------Length of each line-__-q_{7__`____-____-----._ Width of trench---Z-`f--`_-------------------- Type of filter materiaC�J------.---Depth of-filter material----/----'___,-___.Total length___9A__/_____________________________ Seepa dee Pit Distance to nearest well. .__�t'_�'�---Distance from fount ation_______ZO_____--Distance�to nearest lot line___`S_y_____ ❑� �. Number of pits-------------- _____Lining material_ !4 _ *Uize: Diameter________ ___________Depth..... . _ ._ Cesspool:61 ,�Distance from nearest well-----------------Distance from foundation--------------------Lining material-.--____._____._____.________________.171 Size: Diameter-------------------------------------De th----------------------------------------------------Li uid Capacity gals. Privy: Distance from nearest well ___---------------------------------------------Distance from nearest building-----------------------------------------. �p ❑ Distance to nearest lot line------ ---------- ---- --------------------- '1 - - -a-4 .. Remodeling and/or repairing (describe):___.-- �L-- -�--- �_,C�. xs-{SCC.__s-�rc�-------------------- --------------------------------------------------------------•------- ------ -�-- --------- ---- ----------------------------------------------------------------------- ----•--------------------------------------------------------- ----------- ---------------------------------------------------------------------------•-----•------------•---• =-------------------------------------------------------------------'------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r gu tions f the San Joaquin Local Health District. (Signed)-------------------------------- -- -------- --- -- - ---- ---------------------------------------------------------------------------------------------(Owner and/or Contractor) By:---------------_........._......... _--------------- ----------------------- ---------------------------------------------(Title)---------------------- ----------------- -- - - --- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- _70----"u�--------------------------------------------------------- DATE------- " ` '" 6' ------------- REVIEWEDBY-------------------------------------------------- --- - ----- -------------------------------- - ----.- DATE-----=------------•----•-------- -------------------------- BUILDING PERMIT ISSUED---------------------------- - - -------------------------------------------------•-- ------ DATE----------------------------- ------------------------------ Alterations and/or recommendations:-------------------------------------_.............._ -----------------------------------------.-4.d.-------P. ` d,—-------- ------- --�---- ._ --=_ --------- _: -------------------------------------------------------------------------------------------------------------------------------- ----------------•--------------------------------------------------------------- ----------- FINAL INSPECTION BY:........... -------------------------- Date-----�a - le'6� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Es 9 REVISED B-59 3M 3-'63 F.p.CI].