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F R OFFICE USE: 75 d --------------------�`2------------ ----------- - - - - - 1__f.` APPLICATION KOR SANITATION PERMIT Permit No. ... ................. -` ------------------f-o-z.:gLa- (Complete in Duplicate) �a r( ________.__._._ 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 and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--.A7.3__.3 � � -----------••------- ----- --- -------------- ----------------- Owner's Name.__ „••_---------- ------- ------------------------------------ ----------------------------------... ------------------------- ----- ---.__ Phone-•-------•------- - Address------------- - -_---------------..-..... - - ----------�- �� , ---------------------- Contractor's Name------sem ------ --------- Phone--------------•---•---------------- Installation will serve: Residence n— Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___t___ Number of bedrooms __ Number of baths --- Lot size _____60X //D------------------------------ Water Supply: Public system -Community system ❑ Private ❑ Depth to Water Table Z_rft. Character of soil to a depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [�- ardpan ❑ Previous Application Made: [If yes,date--------_-----------) No U3'—New Construction: Yes ❑ No [?•--FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___— Distance from foundation_Z4!_----------Material------12 __.._.__- No. of compartments-------'------------- ___Liquid depth___.__'4--- ----_----Capacity_-- aA�� Disposal Field: Distance from nearest well..-.-— from foundation__zQ-----------Distance to nearest lot line__s._____. [r Number of lines-----/---------------- -----------Length of each line____-7s!----------------Width of trench.------ _�__----------------- Type of filter material___71Cl<rA______Depth of filter material---le--`----------Total length-----�7__.i5 -__________________--___ Seepage Pit: Distance to nearest well------ -------------Distance from foundation------zQ_........ ance to nearest lot line---- ---- Number of pits:__/-----------------Lining material -f _4__G ._Size: Diameter__-_ - ---~--------Depth_.___..-�j---- ----._ Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material----._.____________.____.___________ ❑ Size: Diameter------------------------- - --------Depth_---------------------------------r---------------Liquid Capacity-.--------------------------gals. W 'Privy: Distance from nearest well------------------------------------------,--------Distance from nearest building_.____________________-_-_-_______-. ❑ Distance to nearest lot line----------------------------------------------------------------------- -----------• •------------------------------------------------------- I Remodeling and/or repairing (describe)------------------- - ---------- -------------••---•-•••- -----------•--•----------------------•-------------------------- ----------------------------- ------------------I-------------------------------------------------------------------------------------- -------------------------------------------•--•-------------------•------------------------------------•-------------------•--------- -------------------------------•-------•----------------------------------------------------------------------- -- . ------------------------------------- -------------------------------------------------------•---------------------------------------------------------------------------------------•--------------- ----------------- - I I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulaf s of the San Joaquin Local Health District. '(Signed)---------------------------------------- ----- --------- ----- - -- ------------- ------- --------------------------------------------•------------ --- --(Owner and/or Contractor) BY: (Title)--------------------------------------------- - -- i (Plot plan, showing size of lot, location of system in rela ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY LL!! APPLICATION ACCEPTED BY--------e7.. - --------------------- DATE------- --------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE--------- BUILDINGPERMIT ISSUED-----•-------------------------------------I---------------------------------------------------------- DATE------- ------- -------------- ----------------------------- Alterationsand/ r recommendations:---------------------- --- ------------ -----------------------------------------------------------------•------------------------- --t•7` ten,' ------------- 5f A---------- � ��------------- ----------- -- - ------- -------- -- ------------------------------- --------- ------------------ ------------------------ �,r - - FINAL INSPECTION BY:-.--------Com.- ----------------------------------- Date......... �/rc',S -- SAN JOAQUIN LOCAL HEALTH DISTRICT a 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.CC. !