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FOR OFFICE USE: ------------------------------------------ --- --------- APPLICATION FOR SANITATION PERMIT Permit No. _f-•-7s�.` ----------------------- (Complete in Duplicate) �P�/� Arp Date Issued ----___-_J�_4_ -------------- ----- ----------------------------------- a Issued This Permit Expires Year. From Date 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 A D LOCATION_��C•�-�-A-z.�W:f-- r 7- Owner's Name------- --'�-s--��'��t�`__��,.�-------•-•-----------•-•------------ --------- ----------------------------- ------- Phone------------`------------- ✓] Address------ ��- Y-t- - -- - - -------- ---- - Contractor's Name------------- -•--- _._.........----...--------------------------- -------------------------------------------------------------- Phone--------------------------- .------ 1 Installation will serve: Residen R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] Other [:]r Number of living units: -1----- Number of bedrooms ---,7,-Number of baths _�--- Lot size --------1----- -1-------------------------------------- Water Supply: Public system E] Community system ElPrivate K Depth to Water Table 1.�"ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ] Adobe Hardpan ❑ Previous Application Made: (If yes,date-----------.........) N0New Construction: Yes No E] FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: 1`L ['_� t � i� (No septic tank or cesspool permitted if public sewer is available with n 200 feet.) Septic Tank: Distance from nearest well__/_;9_S77Distance f- m foundation-_._-., Mater'a7i ..... � � : .. ---------------- No. -- k.Z __._._.__. No. of compartments____✓ f_Size�-�- --�---- ---Liquid depth------? ��--- C - -��-- Disposal F;e#d:" Distance from nearewell_..��___-5_._._Distance from foundation----I_,2.___-.__.Distance to nearest lot line--- ------ Number of lines-------------;- -- Length of each line_ Q_` a_ �d#�Ke` trench-___- Type of filter material S_�_I___ Depth of filter material ..-Total length__.___�_ __�z____________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation---.----------------Distance to nearest lot line----------------- 1:1 {Number of pits----------------------Lining material------------------_---Size: Diameter-----------------------Depth-.------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------.------------- 0 Size: Diameter------------------------ • -------De th-------------------------------- -- --_Liquid 'Capacity----------------------------gals. 1 Privy f"D'istarice from"nearest well-------------------------------------------------Distance from nearest building------------------------- 171 Distance to nearest lot line- --------------------------------------------------------------------------------------------------------------------- t- Remodeling and/or repairing (describe)------ � :�t tc _ -----t��--••------_------•-- -------------------•---------- ------------------------• 0 ------------------- it -•--•---•------•--••---------- -------------------------------------------------------•------------- --------------------------------------------------------------------•-••---------------------------------------•-------•-------------------------------- G -----------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------------------------- £ 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. � U9��ISi n -------n�------- --- ---- ---r�-w------------"-----------_- --------------------------- ------------------------------------(Owner and/or Contractor) . BY:-----------------------------------------•---------------------------------------------------------------------------------------_(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 APPLICATIONACCEPTED BY------------------------------------------------------------------•------------------------------- DATE------------------------------------------------------------ REVIEWEDBY-------------------------------- -------- --- ---------------------------------------------- ------------------------------ DATE----6------/ �� BUILDING PERMIT ISSUED-----------------------------------------------------------------� ------------- DATE------------------------ ---------------------- Alterationsand/or recommendations----------------------------------------------------------•------------------------------------•-••-----------•---- ---------- ---------------------------- ------------------------------------------------------------------------------------- - -------------------------------------------------------------------------•----------------------------------------- ---------------- .-_-------- - --------------------- 1 FINAL INSPECTION BY----------------'f --40 �`r Date. (�� / 6� \ IS(k SAN JOAQUIN LOCAL HEALTH DISTRICT E 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street . 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 RrVISED 0-59 3M 3-•63 F.P.CQ.