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F R OFFICE USE: Pe ",4.2-�3 yI3� ----------------- �_ ------------------------- ------I ---- -.- i APPLICATION= FOR SANITATION PERMIT Permit No. ._� ..3_ --------------------- ------------------------- j (Complete in Duplicate),-, ate gg --------____---____________________________.-_.._- This Permit Expires 1 Year From Date Issued , DIssued _ell (x_� 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--3-k3-c? - ------'-----------•---------- -----------------=---------------•--------•-•----------------••------- -------------- Owner's Name_'9774- n ----- Phone-------------•-------------------•-- 1 Address------__ b z %q Contractor's Name-----_------ - - --- -d--: -------------------------------------------------------=-------------------------•------ Phone----------------------------------- Installation will serve: Residence [`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of.living units: __ ___ Number of bedrooms-____ Number of baths j____ Lot size ___/ p _- - -3:3 --------------- ----------- Water Supply: Public system ❑. Community system ❑ Private [ epth to Water Table -. t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑' Clay Loam ❑ Clay ❑ Adobe [B-- Hardpan ❑ Previous Application Made: (If yes,date----------___-------1 .No New Construction: Yes .e---No ❑ FHA/VA: Yes ❑ No ®-� F t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septiic TT�nk: Distance from nearest well`-�_�___.___Distance from foundation___IP -_.._-_.Material__, . ---------------- L"J , No. of compartments_____v�______________Size___ x ._g_..._-___Liquid depth----- -.-.-------------- _._.-___.._ Capacity__ des�__ if l Disposal Field: Distance from nearest well_5-0-------Distance from foundation__`�_f__________-Distance to nearest lot line--c------------- Number ---__-__.Number of lines----_��----------------------------Length of each line----75 - ------.Width of trench----Zf -------------------- j r I V Type of filter materia�� CA-_______.Depth of filter material_.��-$_�_'__- --_Total length-----( --b___________________________ ` r r 00 \N Seepage-Pit: Distance to nearest well__do--------------Distance from foundation___/_0______.___.Distance to nearest lot line.____-_-- .S Number of pifs---:�7--------------Lining material`.?A-C_�-._--:Size: Diameter__-?---------------Depth_-- . ............... Cesspool: Distance from nearest well----------------- from foundation-------------_......Lining material.-.----------------------------------- ❑ t -_ Size: Diameter__ ------------------------I - ---- - Dapth-----------------=----------------------------------Liquid Capacity• - -------------------gals. F Privy: Distance from nearest well---- ---------------------------------Distance from nearest building_-._..__________________________________- �r r ❑ Distance to nearest lot line------------------------------------------------•-------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)----------------- --'-- ---------------------------------•------- ---------------• -------------------------------------•--------------------•------ t -----------------------•------•------------------------•----=•----•--------------- --------•---•----------------------------- ------ .fi ------------ ---------------------------------------------- i I hereby certify that I have prepared this applippfion and hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations the San oaquin Local Health District. (Signed)•--------------------------------------------- -------- {Owner and/or Contractor) BY---------------------- -----------------------•- --------- -------- -- --------------------------------------------(Title)---------------------------- ------- (Plot plan, showing size of lot, location o s relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ �} , - ------------------ ---------------------------------------- DATE-- _ b'- ------------------------ REVIEWEDBY--------------------------------------------------------- -------------------------------------------------------------- DATE------------'----------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------- ------------------- DATE--------------------------- v Alterations and/or recommendations:__Q- _'-_CP -------- -----_..._-t'K- -194A is _&k- -------94A - - -------------- - - t ------------------------------------------------------------- -------------------------------------------------- ----------------------------------------------------------------- ------------------------------------------- FINAL INSPECTION BY:---- C - - --------------- Date_.--- � ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT f 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Era 9 REVISED B-59 3M 3-'63 F.P.00. F i