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FOR OFFICE U, /� ,res ------ J APPLICATION FOR SANITATION PERMIT f Permit No. ..,: v_ � � - ------------------------------------------------------- (Complete in Duplicate) 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 A OCATI N / i � ----------------------------------------------------------------.---- Owner's Name IL,. rC_��7_�i.. r Phone Address------------------------------�-.7--------- _ ( _f---------- Contractor's Name. c?. /T[ --------------------------•------------------------------------------ ----- Phone..-----------------------•--------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-_-- Number of bedrooms ___Number of baths ,/.._. Lot size a'& _ --------------------------------- Water Supply: Public system D-1fo-mmunity system ❑ Private ❑ Depth to Water Tablq&srft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam E] Clay Loam E] Clay E] Adobe ardpan I-]Previous Application Made: (If yes,date_..________________) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No 0' TYPE OF INSTALLATION AND SPECIFICATIONS: e�tc,ic' in we-c/ �,v (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic >n k: Distance from nearest well-----F---�_Distance from foundation__/J--�._!_--_-_-Material_C-C_t9_1Klt__e-- ----------- L e th___. No. of compartments____-____�-�---_-._-Size-_t��'_i/__a_______-Li quid dp. __/�__-____-_,Capacity___90�______ Dispos Field: Distance from nearest well .... Distance from foundation__,)'____---_______Distance to nearest lot line__4_-__-_____ Number of lines--------------j------------------Length of each line------ a f------ ---------- Width of trench d_y-_�`_-___ -_ - ---------- Type of filter material___(%"r_c_ac--Depth of filter material_/_r-/,X--------------Total length-------� _/___________________ r Seeppp It: Distance to nearest well___------Distance from foundafion-� "_.__.Distance to nearest lot iineJ-- -,_____.._ W Y Or Number of pits----/-------_------Lining Size: Diameter --- ---Depth-r.) Cesspool: Distance from nearest well-----------------Distance from foundation------.-------------Lining material_-._.-______________-__.____-.-__. ❑ Size: Diameter------------------------•-------------Depth--------------------------------------------------Liquid Capacity----------------------------gall . Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------.------ 0 ❑ Distance to nearest lot line----------------------------------- ---------- ------------------------ ------------------------- --------------------•-------------------- / Remodeling and/or repairing (describer - �� - ------------ - -- - - ------- - .----•------------------------------- ----------------------------------------------------•----------------------------------------------------------------------------------------• ••--------------------------------------------------------------------------- ---------------------------------------------------- •----------------------•----------------•--------------------------------------------- --•--------•--••-----------------------------------------------•-------------- 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, d rules and gu tions of the San Joaquin Local Health District. (Signed)----------- ---- --- -- - - -------- ---- --`- ------- ------- ------------- ---------- (Owner and/or C ntractorJ -------------------------------------- By:----------------------------- - —----------- - --------------------------------(Title) (Plot plan, showing size o f t, location of system in relation to wells Isuildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- = '--------------------------------------•--•-------------------- DATE---- REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------ DATE BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations------ -- ----- ------ -- --------------------------------------------- ------------------ ----------------------------------------------------- -------- ------ --------------------------- - ----------------------•----------- ---------------------------------------- ------------------------------------------------------- FINAL INSPECTION BY:------ -- c- Date .. -- ----- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-163 F.P.Cp. a