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F/R�/OFFICE USE: T� r 2j ------ --------�r-�� rr- r - `�:_ -(__'__--1 '�_.�- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _____l_f_—/ ! G --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construcf and instal(the work herein described. This application is made in,compliance with County Ordinan a No. 549. 106 ADDRESS AND LOCATION --------- Ir ---- Owner's Name----- -- - ----•--•-- - ----- ----- - •-- ---- ---------- --------------------- Phone------------------------------------ Address----- --- ----- ate- Contractor's Name .----- -••---------- ---•-------------------------------------------•---------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____ Number of bedrooms _ '_- Number of baths.1:71. Lot size _ _ _____f ___ --------_________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Tab€e 40- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San oam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan F1Previous Application Made: (If yes,date__._____-.-__--__-) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic T Distance from nearest wel __' `-Distance from foundation p_____________ Materd?_ 7�",- ___---_._------. � ____________No. of compartments_.-__- ____-.----5ize_ __ _� ' _ Capacity--- b_ Disposal •elcl: c Distance from near e f well_. -Distance from foundationJ—V--------------Distance to nearest lot line_iS-.t.________ Number of iines::=' Length of each line__ �' .4 g Width of tTench. �+ -------- ------------- r Type of filter materia_ _ _AC_A(__--- ---Depth of filter material_/_jY__----------- length____,..-_V-______________________ r �.� Seepage Pit: ._ Distance to near welL_'�_____________Distance m foundation___ ._._.___.Distance to nearest lo} liner______--__- �J' Number- of pifs__- -----------Lining maferial- G;C. ----Size: Diameter__-_:,;�.r�'-_--_Depth__.. ___-.__-.-_. Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material__._._._--____-___--__-_______- ❑ Size: Diameter--------------------------- ----Depth-------------------------------------- -- --------Liquid Capacity- - ------------------------gals. i Privy: Distance from nearest well----------------------- -----------Distance from nearest building--------------------------------------- Distance _-______.___-- _--_-________________Distance to nearest lot line----- ------------------------------------------------------------•--r d Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ -------------------------------------------------------- -------------------••--- ------------------------------•------------------------------------------------------------------------------------------------------------------------------ ------•------------------------------- ---------------------------------------------• __- ------=----- ------------------•---------------..-----------------------------------------------------------------------------------------•-------------------------------- ' ----------------------------------------------------------------------------------=---------------- ---------------- --------------------------------------------------------------- -------------------I-- ----- I hereby certify that I have prepared this pli atio and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulati ns th an Joaquin Local Health District. (Signed)--------------- --------`-------- ----- --- - - ------/owells, ----------------------------------------------------------------(Owner and/or Contractor) '" -------Title (Piot plan, showing size of lot, location of sy fe in relation buildings, etc., can be placed on reverse side). p FOR DE ARTMENT USE ONLY ° APPLICATION ACCEPTED BY-------------------------------------- - --------L 5--------------------------------- DATE-------- REVIEWED BY--------------------------------------------- DATE --------------------------------------------------- BUILDINGPERMIT ISSUED----------•------------------------------------------------------- --------------------------------- DATE------------------------------------- ------- Alterations and/or recommendations:______%_ �.. , ...... - ---------------- ` ` ----------- rANJOAQUIN �G FINAL INSPECTION BY:.. ----------- ------------------------ Date--------� ` ---, ---- ---- LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CC. ti- d