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F R OFFICE USE: lyo._-- ------------------------// r ----- ------------------------------------ __ .____---- APPLICATION FOR SANITATION PERMIT Permit No, J-7------------- ---------- ------ (Complete in Duplicate) Date Issued ----- ----------- ------------ -� This Per Ex ices 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. ' f H. JOB ADDRESS AND LOCATION------_ - - - _ rte �. ----------- Owner's �S 1. 1 Name------------- _-- f � - t 'r - dl � Z_2 Phone--------------- Address r - ----------------------- Contractor's Name--------------•-----•- .�. ; -- -- ---- --' ----------------1- •---- Phone ------------------- Installation will serve: Resideace�[] Apartment•House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units-- -------- Number of bedrooms ---=4--- Number of baths,,____._ Lot size Ace a_j__v---- Water Supply: Public systems Community syste El &'_ to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam C a + � Y ❑� Y ❑ y ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date._..__ _ t ---- }"�No New Construction: Yes No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: C'- `1 i �( (No septic tank or cesspool-permitted if;,public�ewer is available within 200 feet.) Septic T Distance from nearest well--.0_!_ _Distance from foundation__,l_A- _.----_.MateriaL..rLl -rC.-1 No, of compartments-- -------f_! , $ize,,: YS -_- --Liquid depth__. ._. -----__Capacity-•-- - - s 1 . . Disposal F' Id: Distance .from nearest well_-,$� 'Distance from foundation-----/D_______Distance to nearest lat line___ � Number of lines---------- 1 /� - .-_ Length of each line___.__�_Q__�--�- Width of trench.... �l j p y `-------------------- Type of filter material -_ ___ __ e th of filter material__-AQ--___-__----Total Iength________ _;----- ------------ ------ Seepage Distance to nearest ell____ ---_ Distance m foundation-�U__/ -- Distance to nearest lot line_r- --.- - ---- Number of pits _________.-__ 'nin maferial_ ,� g �----._Size: Diameter.3,..5/i --- Depth�� ------- 5 Cesspool: • Distance from nrest well ___--____.._ Distance.f?om foundation___________________Lining matei•ia------ ❑ Size: Diea ___ ameter--------------------- - ------- Depth ------------------------------------------'` Liquid Capacity---------------------------.gals. Privy: Distance from nearest well_1__________ __________.__--__------_---- --Distance from:-riearesf'buildin Distance to nearest lot.line .__---_----------- Remo deling Remodeling and/or repairing (describe)_------------- -------------•-----------------------------------------------------------•--------------------------------------------------=t-----------------------------------------------------------------------------------------GQj ------------------------= ------------------------------ G -------------------------------------------------- +n ---- ----- - --- - - -- ----------- - - --- -- - - ------ - --- ----- r 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, an ales and g 'ons of the San Joaquin Local Health District. (Signed),--------------- ---- --- - - ----(Owner and/or Contractor) r By:------------ - •------------- I--------- ------ Title--- ( � ) -- ----- -- ------ -- (Plot plan, showing size of lot o tion of system i relation`to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY Q----------- ---------- ------------------ DATE--- -------------------------------- - - -------------------------- REVIEWED. BY - IS E ---------------------- --------------------------------- DATE------------------------------------ ----------------------- ------ UiLDING PERMIT ISSUED --- - DATE Alterations and/or recommendations:---- �.1 _'_�--- ---------- -S ---.- -- �f--r-�-- r ------- ------ - -- --- - - ------ t �-- } .PwM-- — 2_ZS........------------------------------- I �p - -------------------------- $M�6 _ FINAL INSPECTION BY: 0 ------- -------------------------- Date-----V,--I SAN JOAQUIN LOCAL HEALTH DISTRICT a, 1601 E.Hazellon Ave. f 4 r 300 West Oak Street -rte,-:; •,_ .4 � t �, , � ?24 Sycamore Street,, 205 West 9th Street Stockton,California } Lodi,California a Manteca;Cafifarnia' Tracy,California �.. E5 9 REVFSED 8-59 3M 3-'63 F.p,CD. i