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O U - - _116o;-------- ------ -- SE---------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------------------------- (Complefe.in Duplicate) Date Issued ---- ------------------------------------------------- --- This Permit Expires I Year From Date Issued Appli cation 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 o. 549. JOB ADDRESS AN CATI 0 ----/ V* ------- ------------------------------------------------------------ ---------------- ---------- Phv Owner's Name on - Address--------------------------------------- ------- ------- ------- - ---------------- ---------------------------- ---------------------------------------------------------------- Lp Contractor's Name --- ----- -- -- -- ---- ---- ---- --------------------- --------------------------------------------------- 1_4------ ------ Phc,46�6 , Installation will serve- Residence El Apartment House El Commercial [3 ra' [3 Motel [] Other,-,g lex Number of living units: -------- Number of bedrooms -------- Number of bath _A irx� ts size e --- ZZ ----------------------------7---------- Wafer Supply: Public system Cormunity system E] Private 0 Depth to Water fableR_,0_ ft. L Character of soil to a depth of 3 feet: Sand C] Gravel E] Sandy Loam;[] Clay Loom 0 Clay [3 Adobe Hardpan 13 Previous Application Made: (If yes,date --------------_) No E] New Construction: Ye No ❑ FHA/VA: Yes F No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ila (No septic tank or cesspool permitted if public sewer is available within 200 feet.)—: % 1. 1 i . Septic Tank; Distance from nearest we_1l_XeK!& Dist'an_ fr'om�f6undafion_ Q__________-Mat rlallw a %e. ------ --------------------------- No. of compartments-_ C7-------------IsizM? V /101Y1__7__^_.S,__ Liquid dep�h. -------------Capacity../,0?4�a�p� DiV Field: Distance from nearest welr)Z*44'Distance from foundation--AR.C-I"----.Distance to nearest.lot line4 v. - S----------- Number of lines______49-------- Length of.each -----Width of trench__.___.__ ---------- 170 Type of filter material-si-A?,c�-k----Depfh,of--Frlfer material----- Total len5fh----/10-- Seepage Pit: Distance to nearest well________________------Distance from foundation-------------------Distance to nearest lot {fine_______._______.. ❑ Number of pifs--------------I-------Lining material-.-_----------- -----Size: Diameter------------------ I ------------------------- ----- cesspool: Distance from nearest well---- ----�_Distance from foundation--------------------Lining material_______..__________-__-.--_._____._._. ❑ aterial-------------------------------------- El Size: Diameter---- -----------------------------Depth---------------------------- -------- ------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well___________________------- ---------------------Distance from near;sf building------------------------------- - C:11 f ❑ Distance to nearest ]of line---------------------------------------------- # — ----------------------------------------------------------- ---- -------- ,,,Rernodeling and/or repairing -------- -- ----------------------------------------------------------------- ------------------------------------------------------------------------------------- ------------------------------------------ -------------- - - - --------- -------- ------ ----------------------_-----------------------------------------------------------------------------------*---------------------------------------- ---------------------- ------------ ---------------------------------------------------------------------------------------------------------------- ----------:--------------------------------------I------------------------ I hereby tify that I have prepared this application and that the work will be done in accordance with San Joaquin County ces, a ordinances, tat laws, and ules-and r-equilations, of the San Joaquin Local Health'District. - ---------------------- - --- Contractor) (Signed)------ 'u-U' o -- --------- - -- ------ ----- weer and/or --- ---------------------- _r�r By:----------------------------------------_--- - --------------(rif le)- - ---------- --------- (Plot plan, showing size of lot, location of syste in relation to wells, dings,,etc.,.can be, laced on reverse side). FOR DEPARTMENT USE ONLY on APPLICATION ACCEPTED BY........I'�:-4tZ7 -,--------------------------------------------------- DATE-------2------- REVIEWED BY------------------------------ -------- t % ----------------- -- ------ - ------- ----------------------------------------------------- DATE--- t----------------------------------------------------- BUILDING PERMIT ISSUED------------------------ ------ -I Z-4----------------- D A!,T I_ °---__--- Alterations and/or recommendations:. y . ..........----- -- ------ ---—------ -- ---- _4 ---------- -- --------- ----------------------------- ------------------------- ------- -------------------------- ------ -------------------------- ----- --- ----------L---------- ------------------------------------------------ -------------- -------------------------- ------------------------- ----------- ------j- ---------------------- --------------------------- ---------------- ------------------ ---------I----------------- ------ - ------------------------------�---- -- --------------------------------------------------------------------/---------------------- --------------------------------- -------- ------------------------------ ------------------------------------------- ------------------------------------ --------------------- --- --------------------- FINAL INSPECTION BY:. Pr7----------------- --------------------------- Date-------------------------- ....... ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca, California Tracy,California 9 REVISED 8-59 3M 3-63 F,F.Co.