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FOR OFFICE USE: II /�� r/ { /'/[ /�—' APPLICATION FOR SANITATION PERMIT Perini+ No. __f.___7...-_._. ____1�./------_-f_--_ --------------- - --------------------------------------- (Complete in Duplicate) Date Issued ____'��"� --� 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 AND LOCATION---- ,!? ---------111_I--?� /2--------------ey ---------•-------------------- ---------- 11 W -; Owner's Name --"-- -------- ..----------_--------------------- -- ----------------------------- Phone_.ff f.O- Address------------•------------------•-•--------r- - tic ------------------------------•-------------------•-----------------------------------------•------------- - Contractor's Name--------- - _-._- Phone. :611 ------- Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer _Court ❑ Motel ❑ Other ❑ Number of living units: __L--_ Number of bedrooms%..f--- Number of baths _.t___ Lot size ------- _______X/-0-Q------------------------- I Water Supply: Public system Community system ❑ �Privateg Depth to Water Table _�©_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy lroam ❑ Clay Loam ElClay ❑ Adobe IT Hardpan E] Previous Made: (If yes,date----------- -----) No ' New Construction: Yes ❑ No �' FHA/VA: Yes ❑ No W TYPE OF INSTALLATION AND SPECIFICATIONS: -- ' '' (No septic tank or cesspool permitted if public sewer is available within 204 feet.)I Septic Tank: Distance from nearest well________________Distance from foundation____________________Material--------------- -------------------------------- ❑ No. of compartments--- -----Size----- :------ "' Liquid depth Capacity;.---.. Disposal Fiel Distance from nearest well-___`----Distance from foundation____�a__'----Distance to nearest lot line_______.__---_ J Y, Number of lines--------------1-----------------Length of each_line-------•-� - Width of trench------------z-`�- -------•-- N ��,_ g _ Type of filter material.____:C _.________ Depth of filter material-:-_,_L "-__._.Total len th___________________ Q`------------ Seepage PI : Distance to nearest well---%3-0__`_........Distance from found ation_-_-6' > D� Lance to nearest lot line__._-&___-____ Number of pits----- _ C� q t (� ,l._.._________Lining material Diameter__.._____�_ ___:�___.Depth___._____.__-2.�-__-.----- Cesspoal: Distance from nearest well-------___-------Distance from foundation____.____..-----_..Lining material-__.___________---.__._________ -___. ❑ Size. Diameter-------------------------------------Depth------------------ --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------------.---------Distance from nearest building__________-___.________---._____.____.._. ❑ Distance to nearest lot line------------------------ -- ---------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):----------f w,/_------7'c�------- / '•------t5 _.5 ------------------------------ 1 l ---------•------------•-------------------------------------------- ------------------------------------------------ - - --------- --- 5 --------------------------------------------- ---------------- ------------------------- -------------------------- --------------------------------------------•--:-----------------------------------------------------------------------------------•------------------ 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 regulations of the San Joaquin Local Health District. ,.7 M (Signed) ---- -------------------------------------------- ----------------`-- Owner and/or Contractor) gY ---------{Title) _ ._ . (Plot plan, showing size of lot, location of sysierrillifn relation to welO buildings, etc., can be placed on reverse side). • FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ." Y -------- -------- DATE------�/-- �� REVIEWEDBY------------------------------------ --- -- --------------------------------------- -------------------------------------- DATE------------------------------------------------------------ BUILDING UI DI ons and/or recommendations: -- ---------------•------------------------------------ ----,.DATE--------- --------------- ---:-�-------------------- Alt ---- --- --------- `--'---'---`____"'"- `- `- , .4..c_ C.._ ------------/ -- --- --C/-` �_�- j -lZ `}' � -.------------------------ - --------------------------------------------------------------------------------------------------------------------------------- ----------I------------- -------------------------------------------------- - --------------------------------------------- --------------------- ----------------------------------- -- - -------------------------------- --• ------ ------------ ----------------------------------------------------- ----------------------------------------- ----------------------- ------------- ----------------------- ------ -------------------------------------------- -------------------------- ------------------- ------ ----------------------------------- Z'/. FINAL INSPECTION BY:..--75L7_ -- — --------------- Date-------- ��---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California a x ES 9 REVISED 9-59 3M 3-'63 F.P.CO. - -