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FOR OFF lc>= use: -- ------------- / ------------------------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. ...-�5�. �I (Complete in Duplicate) Date Issued .-- --_----_------------ -------_-------._-. This Per Expires 1 Year From Date Issued o5$ r /so 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 LOC TION ),,_,0!__/---- 3411 r-------•---- �� .� ------------------------A—IL----------------- r Phone..---------•------------ Owner s Name �'� •-- ---Address------------_ --•------ �Z4_ ---- -•-------------- - Contractor's Name--- .- Phone i Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ el ❑ Other ❑ Y Number of living units: - --- Number of bedrooms� -Num��fo s� Lot size ---- ---------- --(---. '-a�-------- Water Supply: Public system ❑ Community system ❑ Private Water Table ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San Loam ❑ Clay Loam ❑ lay ❑ Adobe ardp ❑ Previous Application Made: {If yes,date--------------------) No 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 Distance from nearest well_-,�V.____-Distance from foundation -_-- ------ _...Mat�lal__.0 -. ------------------------ ---- No. of compartments__--- -------------Size---,.� - s. / �iLiquid depth--- -.-------------Capacify- - �__-- Disposa}/ ield: Distance from nearest well..-� _.�-_Distance from foundation-- -f-----.--.bis#ante to nearest lot li e--------46--------- a------ of each line---�a _YV.9V---Width of trench----�- _---------------------- Number of lines-------- - Type of filter material___ 4 _�C----Depth of filter .material----�_9/--k---.--Total length - a Pit: Distance to nearest ell- ___� .l b �l ---.Distance to nearest IQt line-- �---. p` '----_Distance from foundation--- ----------- �� f Number of pits-------t .-------Lining mat erial__-ty"_�_- .Size: Diameter-- --.-.- -----Depth---- ' epi ------------------ Cesspool: 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)-------------- — ------- - ---------------------- --------------------------------------------------------------- ----------------------------------------•--•---------- ----------•-------------------------------------------------------------------- I hereby certify that I have prepared this application and that the•work will be done in accordance with San Joaquin County ordinances, State law.U101 druand r u tions of the San Joaquin Local Health District. (Signed}------------------- Q ----------------------------------------------- -..-(Owner and/or Contractor) By:------------------- ----- y - - = ------- -------(rale}---------- (Plot plan, showing'size of lot, I a on of system in relation to wells, 1311110ings, etc., can be placed on reverse side). FOR DEPARTMENT USE O LY APPLICATION ACCEPTED BY ,' I C DATE----------- -- 1-�.� REVIEWEDBY-----------------------•------------------------------------------ ------------------------------ --------------- DATE------------------------------------------------------------ ------------------ BUILDING PERMIT ISSUED------------- -•------------ ------------------------------- ---------'- DATE Alterations and/or recommendations---------------- --- ------------------------------------------------------------------------------------------•--- ----------------------- ------------------------ -----------------------------••--------------- - ------------------- --------------------------------------------------------•------------------- /o -2-z -C3 FINALINSPECTION BY:. - ----------------- Date-------.----------------------_- --- --- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California Ewa 9 REVISED B-59 3M 3-'63 r.P.CO.