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F R OFFICE USE: r 7 --------------------I.1;-------- APPLICATION FOR SANITATION PERMIT Permit No. 1/.7-�-j--- ------------ -- ---- ---- ----------- ------------------ (Complete in Duplicate) --------------------------------------------------------- This Permit Expires 1 Year From Date Issued 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_ -------------------- = a-----�1- - 'a ��' _"`�' Owner's Name---------- - ---- ---.----- --•. --------------- Phone-�-�----• t o � �--- -- - �-- Address ' --+ ---------------------------------------------------------------------------•-----------------._....-- Contractor's Name-- ---- ------------------ ••-- ----- i--------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: _A__._.N*nber of bedrooms Number of baths _(r_.__ Lot size ----------- 0__.X__.__15__4_-________________ Water Supply: Public system gEt- Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E_ Hardpan ❑ Previous Application Made: (if yes,date--------------------) No 2 New Construction: Yes ❑ No p- FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material____-___-___-_-__-______-_-___---------_-_____. No. of compartments--------------------------Size-------------------------------Liquid depth---- ----- ------ --------Capacity------- --------------- Disposal ield: Distance from nearest well_---__-___--____Distance from foundation____________________Distance to nearest lot line___-_______--_.-- Number of lines---------------------- ------------Length of=each line--------------------- ------- Width of trench.--------------------------------- Type of filter material-------------------------Depth of filter material------------------------Total length_----------------------------------------- 0 Seepage Pit: Distance to nearest well__/Ugk_-Q------Distance from foundation--/d.-__-_---.Distance to nearest lot line_S_________-__ Number of pits___-:_ _'---------Lining material__ Size:,,Diameter---197S " V___Depth_ $_.--_-.. Cesspool: Distance from nearest well-----------------Distanclr from foundation---------------------Lining material._________________-_____________-_-_ ❑ Size: Diameter--------------------------------------Depth--•------------------------------------------------Liquid Capacity-- -------gals. Privy: Distance from nearest well_______________________________-________.----Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line----------__________________. -------------------------------------------- 1+1 0 Remodeling and/or repairing (describe):--------------------------------------- ------------------------------------ ---------------------------------••---------------------------------------- --------------------------------------•----------•---------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- ------------------------------------------------------------------------•----------------------------------------------------------------------...-..------------------------------------------------------------------------- ------------------------------------------------------------------------------------------- -- ---------------------------------------------------------------------------•--------------------------------- ---I------ 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 th an Joaquin Local Health District. a[ 1 g 9 (Signed)------------- ---- -- -------- ----- ---- � c-------------------------------------------------------------------------(Owner and/or Contractor) By------------ ------- -- -------------- •• - (Title) ---------------- ------------- By: 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 - 4--------------------------- ------ DATE-------- - REVIEWEDBY--------------------------------------------------------- ----------------------------------------------•--------- ------ DATE------ ---------------------- ------------------------------ BUILDING PERMIT ISSUED---------------------------------------------------------------------------- -------------------r----- DATE------------- - Alterations,and/or recommendations:__-________E?�l ./- __.`f--._.._-__ =r-, "`:mac__ . . -+ .._.__/. __ -- '' y t L`. r-' ---------------------------------------------------------------I---------- --------------------------------------------------------------------------------------•----------------------------- ---------------------------- -------------------------------------------- ------------------•--• -�I------------•---------- ----------------------------------------------------------------------------- ----------------------- /i� f FINAL INSPECTION BY----------- ------ ---- --- '---- --"J------ Date-------------,------ ----• -------------------------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 00 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-59 3M 3--53 f.P.gD.