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FOR OFFICE USE: --- ------------- - Permit No.,l7__4!q•--- ------- ------------------------- APPLICATION FOR SANITATION PERMIT ---- -------- ------------------- -------------- _ _ (Complete in Duplicate) Date Issued---a=• -- ---_ -------- ---------- - ------------------- }------------ r This Permit Expires 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, 544. USS=�?�' 0�f _ JOB ADDRESS AND LOCATION----- S Phone------------------------------------ Owner's --------------------------•--------Owner s Name_ ________All- Address----------- Address_...------- fes+ `7 " ------------------------ -�_�___' --------------------------------------------------------------------------------- Phone----------------------------------- Contractor's ------------------------ Phone.------•--•-----•----•------------- Contractor's Name------•- - - ---------••---•-----------•---•-- ---- Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _L.____ Number of bedrooms l_._-- Number of baths _I___ Lot sizeel d'6/ Water Supply: Public,system ❑ Community system ElPrivate [UDepth to Water Table 7-457-- ft. Adobe Hardpan Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ ❑ M;. -' Character of soil to a depth of 3 feet: Previous Application Made: (If yes,dat �1Y,.4_kNo ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j Septic Tank: Distance from nearest well__ d-'- Distance from foundation ---�- Material_ %v 1 ,No. of compartments_.. Size__.' r Liquid depfih Capacity - _ well__�70-------Distance from foundation_-1 D.- ---- Distance to nearest lot line__�_.�_____- 1 Disposal Field: Nlumanceberr of lnes�a � �-- -------------------Length of each line_______- '- ------Width of trench---,;'--'/-_`__-.------------•-- F ( _/ Q Type of filter matenal;�'If--Depth of £ilter,matenal___�_1_-:_----------Total length__ ___G'b---------------------------- Seepage Pit:. Distance to nearest.well-----__________---___Distance from undation____.____ ___.:___.Distance to nearest lote----------------- Seepage ___-_.______.__ Linin material: -----Size: Diameter__-- ��- ------De tn--- -------------------- Number of pits.---� ----- 9 `p p Cesspool: Distance from nearest well-----------------Distance from foundation---_---------------_Lining material-_._._-----_______-- � Size: Diameter------ ------------------- ------ -- Depth-------------------------------- ---•--------------Liquid Capacity.--------- gals. Privy: Distance..from nearest well_________________________ .� : ❑ ----------=----------Distance from nearest bui�cling------------------------------------------ a _ �-- Distance to nearest lot me______________________ ----------------------------------------------------------------- Remodeling and/or repairing (describe :------------------------------------ ------------------- ---------------- ---------------------------•---------------------------------- --------------------- ---------------- -------------------------------------------------------- --------- --------_----------------- ------------------• ______________ R_------------- --------.__-____-_-________________________..________________-______________.__________-_________--____________.________.---____________--_________-_______..____.___..- : ----- --- -_ _ I here_by_ __certi_fy__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 re Mations of th to Joaquin Local Health District. ----------- ---(Owner an r on r c tor (Signed) _ — ( Itl ) - � St -:-- = __ .. Z. .• --- BY. ------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY - - _` _�y--------- ---------------------- APPLICATION ACCEPTED BY_ _ -._ -- ----------------------------------------------------------- DATE ----------- DATE-- __-_-- --- - ------------ REVIEWED BY- DAT -------------------------- -------------------------------- DATE------------------------------------------- ----------- Alterations and/or recommendations------------------------------------------------------------------------•-------- ---------------------------- BUILDING PERMIT ISSUED----------------------------- ----le-- -------------L&-------- - --- 4----------- --------------------------------- s �' • �C______ ---- = `` ----------------------------------- ------------------------------------------------------------ - --� - ------ - - ---- ---------------- FINAL INSPECTION BY-- - ----- ---- -- — ` SAN JOAQUIN LOCAL HEALTH,DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California ES 9 REVISED e•59 3M 3-•63 F.P.CM { '' a