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FOROFFICE USE: ---- -------------- ----------- "..---- - -------- - ---- -- -- --------------------------------.. ---------- APPLICATION FOR -SANITATION PERMIT Permit No. .. .1_ ----- -------------------------------............. (Complefe-in Duplicate) ----- .. .. .. ... . . .. . ................ This Permit Ex ires 1 Year From Date Issued/ „lett Date Issued -fir . -.�7 Application is hereby made to the San Joaquin Local Health District for a permit to cons�k4t'a�'ndr install the work herein described. This application is made in compliance with County Ordinance No. 549. ;r't f22 AJ , f-rl 444 WA- JOB Q r� JOB ADDRESS AND LOCATION ------- � Owner's Name ' s V_5_4 --------------- ------- -------- -- - --------- ------------ Phone------------------------------------ Address----- . - - ---- --------- ---------------- Contractor ------- 7- Contractor` Name. • - ---- ------------- Prone------ ---------------------------- Installation will serve: Residence 1� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _l_._.. Number of bedrooms ___ Number of baths._1---- Lot size ----- --- -------- -------- -------------------------------- Water Supply: Public system ❑ Community system E] Private � Depth to Water Table 7Q . ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam] Clay ❑ Adobe ❑ Hardpan, ] Previous Application Made: (If yes,date------------------- } No ❑ New Construction: Yes 0 No ❑ FHA/VA: Yes E❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: n , (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) __ 1j Septic Tank: Distance from ne rest well7r_ Distance from foundation--1_Q------------Material --- ---------------------- 21 No. of compar Clts.-*"_Size-Y �-f '�-(------- --.Li quid de p.th.-. #- --------Capacity/,'-�---#-* --- Disposal Field: Distance from nearest well--7r.......Distance from foundation.4% ----.-----Distance to nearest lot line---C_------ Number of IInes..-d�..................... ...Length of each line_. . .__b..'Za-.-.Width of french---;-.�--------------..-------- Type of filter material-1-1-I A-----------Depth of filter material-j.l-.1f----------Total length../r0------------------_--_----- Seepage Pit: Distance to nearest well./,L.,r........Distance from- foundation--l--------...Distance to nearest lot line,'-.Q.. Number of pits__. -_----____._Lining material--�OCA0--.._. Size: Diameter--- 3cg. ____-_---DepthA_'_--------------------- Cesspool: Distance from nearest well ----------------Distance from foundation................. ..Lining material-.......___-______-------------..." - ❑ Size: Diameter- -- --------- ----- --------------.Depth- ------------------------------------------- ......Liquid Capacity----------------------------gals. Privy: Distance from nearest weft....---------------------------------------------Distance from nearest building_------......---.._._....-------------.". ❑ Distance to nearest lot line -------------- -------------- --------------------------------- ,S " Remodeling and/or repairing (describe):--------------------- - ------ - ------ -•-------------------------------------------------- ----------------------------------------------- .Q -------------------------------------------------- ---------------•----- --- -- ------------------------------------------------------------------------------------------"----•---------------------------------------------------------------------------------------------•------------------------------ --------------------------------------------------------------------------------- ---------------------------- ------------------------------------------------------------------•------------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a laws, and rules and regulations of the San Joaquin Local Health District. v.,45 (Sig ned f M_ _ ........... ..........................(Owner and/or Contractor) By_u - ?� -- - - ------ ------ - ---- ------ -- -- - ------ (Plot plan, showing size of lot, loco; ton of system in relation to wells, buildings, a+c., can be placed on reverse side). 49 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY f ----------------- --------------- DATE- REVIEWED BY-------------------------- ------- ------------------------- DATE----- - BUILDING PERMIT ISSUED----- ------ DATE--- ----------------------------------------------------- -- Alterations and/or recommendations:--------- ------ ----- --------------------------------------------- ----.. FINAL INSPECTION BY: Date..6--� ..-.~.� - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi California _ Manteca,California Tracy,California E.H.9 2M 1•67 Vanguard Press