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FOR OFFICE USE: r� ,-- --------------------------------------------------------- r� g ----- ----------------------------------------- --------- APPLICATION- FOR`SANITATION PERMIT Permit No. 1_4------ -`----->--- ----- ------------------------ (Complete in Duplicate) j -------------- This Permit Expires 1 Year From Date Issued .3.. Date Issued ______ Applica+ion is hereby made to the San Joaquin Local Heal}h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. f e JOB ADDRESS AND LOCATION-. --- -- --- ----- - ----------- r - -------------------------- f Owner's Name-_- $_W - - ----------- -- ----~-- J- - --.-. Phone----•----......---------_: - ------------- - Address------`�~.3S.�o �d r.._ ----------------------••----------------------------------•-•------------- Contractor's Name- ---- :_ a`` -�. ----------------- -- Phone..-------------....._ Ins+alfa+ion will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A____ Number of bedrooms Number of baths _J__- Lot size ___ _______________________________ � Water Supply: Public'system Community system ❑ Private ❑ Depth to Water Table � f#. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Ilf yes,date---------- ---------1 .No New Construction: Yes, N o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: I } (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic rnk! Distance from nearest well____~_____:Distance from_foundation_�p_____________Materia4____�____._______.------------------- No. of compartments_._ -------------------Size-----3_X7LX__9-:---Liquid depth------ ------------Capacity---?_q Disposal Field: Distance from nearest well _ --------Distance from foundation_JA-----------Distance to nearest lot line_ `-____ Number of lines___ ______________________------_Length of each line---- `___-_-_.___._--.Width of trench.--g-9-.-- ------------- --------------------- Type of filter material_&�•_4t_ _ _ __ _ _Depth of filter material___ _____._ _ -_,Total length___-_�_�__-___________ W Seepa fPiti Distance to nearest well-----------------------Distance from foundation_1�?________-_-.Distance to nearest lot line__`--___-_-_-_ 6 0 Number of pits-----I----------------Lining materia__ QG.�______-Size: Diameter.3,_?_ _._._.____Deptn____.?s.`_� ---------------- 0 k Op Cesspool- Distance from nearest well_____ _'_____Distance from foundation--------------------Lining material------------------------------------- Size: --______________________ __________Size: Diameter------------------------------------- Depth------------------'- ------_----- --------------.-Liquid Capacity----------------------------gals. N Privy: Distance from nearest well ___------------- ------------------------------Distance from nearest building----------------------._______--____-_. El Distance to nearest lot line -"----------------------•----------------- Remodeling and/or repairing (describe)=- - ---------------------- ----------------------------------_ �. ---------------•-•---------•-•----------------------------------------------------------------------------------------------------------------- -------------------------------------------•- ;.fi ----------------------------- r R _ i ' �p 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. �(Signed) � ! _____________ Owner and/or Contractor) y iBy--------------`--------- —---------------------------------------------------{t-------------------(Title)----------I------- ------- ---- ... -- ----- (Plot plan, showing size of.lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY . -- --- ---------------------------------•----------------------- DATE------ 024/_12 ----------------------- REVIEWEDBY-----e-------------------------------------------------------------------------------------------------------- ------------- DATE-------------------------------------------- _-------- BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------------. DATE------------------- Alterations and/or recommendations:- — Fel --------------------------------------------------------------------------------------------•------------------------- i --- -----------------------•--------- ----- ------------- ----•------------- ----------------- -•---- -----•--•-•-------------- ------------------------------------- ----- -------------------------- ------ FINAL INSPECTION BY:.... == --- --------------------------- Date---. ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT l 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore 5treet 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-59 3M 3-'S3 F.P.CD.