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FOR OFFICE jJSE: a ------- ----- ------------------------------- - --------- -- -- ---------------------------- APPLICATION -FOR SANITATION PERMIT .. Permit No. - } (Cc" le#e in Duplicate} Date Issued ---------------=-- 5 J -- ---------------------- This Permit Expires i Year From Date Issued 2-2-49—(9)D —12- Application (ZApplication is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in complia e:. :.C. my Ordinance No. 549. 106 ADDRESS AN LOCATION___-- -= _.- ="1�C p _ ___: �n _-..-ZC�---- ---- ------Q.E------ H _H------ 14 ----- �L_ :-------- Owner's Name L�� ---Rl�I)x -T- D-------.f y/I _ .L7_ Phone. Address--------3J.!�-.--------W------ �CI_I 1 ------•----------- --mI''(-----------------------•-------------------- ----------•-------•------------••-------------- Contractor's Name_ T _.._. ± PTfR1 C Phone.. Installation will serve: Residence er Apartment House ❑ I,Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1-----Nurra`ber�of.bedrooms _ -' Number of baths _ Lofi size _________ ______ _ --- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -!� ft. j Character of soil to a depth of 3 feet: Sand 21'GraveA❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date ) No` New Construction: Yes 2r--No E] FHA/VA: Yes E] No TYPE OF INSTALLATION AND.SPECIFlCATlONS _ r - . .Y_ - ._ - _ w (No septic tank or cesspool permitted=if..publrc ewer.is avatlal;le within 200 feet.} �' ..wl fir, Septic ank: Distance from nearesF well-__ .='._____Distance,from foundation--. . J j�------- Material----CC C�'._t.F_7 -------- r No. of compartl,,�a'`ents-.-- - ---�-__-- , �. ��-�-X-�-------Liquid depth---��---.----Capaeity../�-C�.© Size--- ---- - ------ 1 ' Disposal Field: Distance from, nearest well-.- __---Distance from foundation-__.�?___._-.Distance to nearest lot line _ _.._.._ It Number of linesr_°_.Z- __________.____-_Length of each line_______________ - 'Width of trench....__ _.� y.i Type of filter matei -----Depth of filter material-----/ `• 'Total length---------------- __ .___ I" Seepage Pit: Distance to nearest well....-. --------------Distance from foundation to nearest lot line-- --$o _ __._. F1 Number of pits--------3-----.---.--Lining material-----------------------Size: Diameter--j.___-...-.-.-.--_--Depth------- ------------------------ .J'� Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material--.------- ------------ ------------- S: ❑ Size: Diameter_._. -------- -Depth------------ - -------------------- -------------=--:Liquid Capacity--------- -------gals. Privy: Distance from nearest well-------------------------------------------------Distance from n6arest building------------------------------------------ 0 Distanceto nearest lot ------------ -------------- ---------------------- --------------------------------- ------------- --------- ---- vil I #( Remodeling and/or repairing (clescribe)a------------------------------------------------------------------------------------------------•------I---------------------------- l ---------------------------------------- ------------------------------•---------------"---------------------------- ----------------------------- i t I --------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules and regul ions of the San Joaquin Local Health District. }� 'and(Signed}------ --� - - ---------- -- {Owner /or Contractor) B _. :. -- ----------------------- -�=}-------------------- _ ------ ------(Title}------------'-�------------ - -------- (Plot plan, showing size of lot, location of system in relation to wells; buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY l 1. --------- -------------- ---------------------------------------- DATE- �1 ?` `f ----------------- REVIEWEDBY----- - ------------------------- ------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------- -------------------- -----------------------•----------------------------- --------- DATE----- ---------------------------------- ------------------- Alterationsand/or recommendations:------- --------------------- - --------•---------------------------------- --------=--•------------------------------------------------------------ ---•----------- I --------------------------------- ---------------------------------------------- ------ -------- -- ------------ .___..-. . ------------------------ ----------------"-------------------------------..----------------------------------.--------- FINAL IN ION BY:. - - - ----- Date. r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ka:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r F-P.C Q.