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FOR OFFICE USE: 15r� •� 6 ` --------- ---------- �' ,,._ Z.-. --------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------ -----------=-- ---------------- ------------------ _:r- (Complete in Duplicate This Permit Expires 1 Year From Date Issued Date Issued ---�.__ ___JTO Application is hereby ;nada 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. r t . JOB ADDRESS AND LOCATION----------//- /tel//�f4.1 Owner's Name............ - �4/LA �Z./ r.-: - ------ Phone------------------------------------ Address----------------------- ---------------------•---------•---Address----------------------- 4� '-Si2Cs ---------•-----------------------------•--- Contractor's Name_____:_____ _ l f l?�_-------- ...X?`-------------------------------------- ------------------•-•--- - Phonel /,,�-�.'�..2A i Installation will serve: (Residence [+Apartment House Commercial E] Trailer Court E] Motel E] -Other E]f r �� Number of living.units: :_�_, Number of bedrooms :�._ Number of baths Z-�Lot size Water Supply: Public'system ❑ Community system ❑ . Private Depth to Water Table . - ft. Character of soil to a depth of 3 felt: Sand E] Gravel E] Sandy Loam [❑ Clay Loam E] Clay E- AdobeN' -Hardpan C] Previous Application Made: (If yes,date................__.) No V New Construction: Yes ❑ No W FHA/VA: Yes ❑ No;N�- TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: IDist_ance o. of comp from neareartme st well __.__ -Distance from t . foundation------•-----------..Material ---------------------------- ------•-•---. p Distancelfrom nearest nts.^ Size ` Liquipth d de :_ Ca P f acifit y_______________________ r r f Disposal Field: well._- Q----,Distance from foundation----_ .__.__,Distance to nearest lot line___t:w.. ------ Iti Numberof fines- _---___ 1` - _ _L ngth of each°line--- _------74 .... .-Width of trench{ --------- ..-- - Type.of,filter.mate�ial:- 5 ,�_-Depth of filter mMerial_____ /_/tF _.____Total length---- -----------/' ------------ Seepage it:. Distancettornea'rksf'well___-_7,S'------©istanCe-from�foundation_-__30__�__.Distance to nearest lot €ine_____Z�-�- dNumber of pits-_ --------Lining material__ %�CjC_�Size: Diameter---_ Depth__.__.___ Cesspool: Distance from nearest well________________Distance from foundation.------------------ Lining material-_ ___--_..__.__________---_.___.- I!E - ❑ Size: Diameter- �--------------------- 3 -------Deoth-------------------------------------------------- Liquid Capaci#Y gals. l ..- --- --------------- :I s . ....sir � s .. Privy: _� Distance from nearest well_..__-�_____________________________________Distance from nearest building________,________ :5:7 ❑ Distance�to nearest lot line------ = --------------------------------------------------------------------- --------- Remodeling and/or repairing (describe]:______._-.__ --- --- ______------------------------------ - _____________._____________-• - / � ------------------------'� "=- Tom- •v6 S�<,S r- r'. - I, t ....�.�.. ,:. .. ' will ordinancesbSta to la that and rules ules an regulations of the San Joaquin Local kHea be d trice. accordance with San Joaquin County i r Health District. (Signed)__ _.. - - ------------------------------------- er and/or Contractor} --- ------- el, BY� -------------- ----- ----------------- (rile) &�7_ --------------- ---- - ------------ (Plot plan, showing size of lo}, location of system in relation to,wells,,buildings,,etc.,can be placed on reverse side). (; FORDTMENT USE ONLY REVIEWED BY - ' - `- j li = DATE -�` 4 APPLICATION ACCEPTED BY_ ---._ --_,.�___ ___ - - . --------------------------------------------------=------ DATE----------- - BUILDING PERMIT ISSUEDJ------------- -A � � - _ D � �.. ._ - ATE Alterations and/or recommendations __. �% Zr' / r t f -•----- c� . - ! - . ---------------------- -------- • -------------- --------------------t ` ------------------------------------ ------------------- - --------�-- 'X--------------------------------------------------- -----------------------------•------------------------ - •------ -------- . t --------------- -------------- I! FINAL INSPECTION BY ----- Date .._J...�� I 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 E3 9 REVISED 8-59 3M 3-63 P.P.gp. a1