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FOR OFFICE USE: ----- ------------------------------------------- ------- •�-� _1,1/_.41.1-Ir--------------------- APPLICATION FOR SANITATION PERMIT Permit No. - (Complete in Duplicate) Date Issued -----=---- This Permit Ex�ires 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. 549. JOB ADDRESS- AND LOCATION_______________`y___4__!y_r__---/-1`-- - �-t, Owner's Name------------ t--- -x------ -------•----------- -•------------------- --------------------------------------- Phone. i_--- Address ' `� Contractor's Name ! '- r ------ Phone.. •- Q r--- z l C rtF( Installation will serve: Residence ©— Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ti t r A Number of living units: ___l____ Number of bedrooms _Z._ Number of baths _ I--- Lot size .___.____�_1 ...... _x_ _______________ Water Supply: Publiclsystem ElCommunity system ElPrivate E!r Depth to Water Table .4r ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[tom Hardpan El Previous Application Made: (If yes,date------_- --------) No [j} 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.) r r / Septic Tank: Distance from nearest well---�d_._____Distance from foundation.___/(3__._._- Material d d-J---- ------------- No. of compartments----___A--------------'Size.--------��-`��---:--•Liquid depth_____-..Y. ------------Capacity---a�-a-��f f Disposal Field: Distance from nearest well.._.4�°..'�___.Distance from foundation___ d_----------Distance to nearest lot Number of lines---------1-----------------------Length of each line---_-----�/.-P_............Width of french....... .-r---------------------- 6 ..Type.of filter material___Raj;�_'t-------Depth.of filter material----- _b'_��,_--_-_Total length_-------7.A-------------------------- f T� y Seepage Pit: Distance to nearest well___ v_`�__r__.___:Distance from foundation___/U ---------------- to nearest lot line__s ------- .V) Number of pits-------!..___.------Lining mate --Size: Diameter__31.""----------Dept __________________ Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material---------- -- __--"----__________..____. Z ❑ Size: Diameter-------------------------- ----------Depth----------------------------------------------------Liquid Capacity--,,----. --------gals. Privy: Distance from nearest well-------------------------------------------------Distance from-nearest building------------------------------------------ t ❑ Distance to nearest lot line--------- ------------------------------------- ••--------------------- ------ ---------------------- Remodeling and/or repairing (describe):-__Ca_IiF/'-f_ +-- -, -p�-- ---- ------- -- ---- - - - ---------- --- - ------------------------------------- I hereby certify 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 regulations of the San Joaquin Local Health District. r (Signed) r -----------------------------------------=-------------------------------------(Owner and/or Contractor) By:----------- =; `£---- --- - - ---- --------------------------------------------------------(Tif le (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 -------= �r =---------------------------------- DATE------- �,7 _ REVIEWEDBY -------------------------------- --- - ------ ------------------.------------------------------------- DATE---------------------- IBUILDING PERMIT ISSUED------------------------------------------------:--------------------------------- --------- DATE---------------------------- -- -------------------- Alterations and/or recommendations:___'__ - -T --- /—/-----�-----y----- 1 ---------T------------------------ E ------------------ ------------------------- ------ ------------------------------------------- ----- %FINAL INSPECTION BY:------ ...... ---- ---------- Date------ ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.ffa:elton Ave. 300 West Oak Street 124 Sycamore Street 245 West 9th Street Stockton,California Lodi,California Manteca,California e Tracy,California ES 9 REVISED B-59 31A 3-'63 F.PZQ. s. I