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FO OFFICE USE: �a y ��r gJa _ ✓� ------------ - APPLICATION FOR SANITATION PERMIT Permit NO. 17 - f ----------------------------- ------------------------ (Complete in Duplicate) _141 ---------------------------------- ------ --- ----------- 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 compliancea with County Ordinance No. 549. JOB ADDRESS AN OCA I N - --------- - ----- / l - Owner's Name- X -Z.- 46----------------- _ 77--- -------- Phone-------------------------------- ------------ Address - -------•----------------------•--------------------------------...--•------------------------------- Cantractor's Name------- ---- --- -- - Phone----------------------------------- Installation will serve: Residence Z Apartment House 2, Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - - Number of bedrooms -.,Number of baths _e2- Lot size - ., �______________-------------------- Water Supply: Public system ❑ Community system [IPrivate �epth to Water Table _4,e-6tt Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑' Clay ❑ Adobe ®-IH-ardpan ❑ Previous Application Made: (If yes,date---------------_---) No 5��lew Construction: Yes R?-117❑ FHA/VA: Yes ❑ No a TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) :F Septic Tank: Distance from nearest well_oro e_-Distance from foundation n ----le--.--_-.Mai L-- ---------. �y1 No. of com artments-. _ --------Size ._ --_- p p s > � X Liquid depth -�,� Capacity - A O W fl Disposal Field: Distance from nearest well./"--- Distance from foundati n-- -� Distance to nearest lot line-,�_--.-------- i Number of lines------ Length of each line----YQ--- ------ ---- trench ,02-:1 of trenc -. - _ _ _ - ---.-- --- -- --.--- S Z Type of filter material- .Depth of filter material__��- --Total length__X_e41;P------------------------ %P Seepage Pit: Distance to nearest well...Z� -------Distance frog fo}dation__./.0—_----..Distance to nearest lo line--- ------------- � Number of pits:_-. ---.._.-.--Lining material-- �.Size: Diameter.-.�.-------Depth-1 Cesspool: Distance from nearest well--_-------------Distance from foundation------------------- Lining material-_-------------_-_.--_---___-------- LlSize: Diameter---------------------------- Depth------ --------=------------------------------------Liquid Capacity------------------------....gals. Privy: Distance from nearest well--------------------------.----------------------Distance from nearest building_---.----.-----------_-------..-..---. ❑ Distance to nearest lot line----------------------------- --�------------ ------------------------J-------_---------------------------------------------------------------- Remodeling and/or repairing [describe}:_-___4- ----_� --- ------- �- �- � _._..----- -------------------------- ----------------------------- - --------- - -------- --= ------ --------------------------------------------------------------------- `•---- --------------- ------------------------------- --------:-•------------------------=---------------------------------------------------------------------------------------------------------------------- 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. ,._. By:----------------•--•--•--••----------------------------------------------- - ------ -------------------(Ti+le)-- 2��F ................ (Plot plan, showing size of lot; location of system in a+ion to wells, buildings, etc., can be placed on reverse side). t= ryra FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED°BY ----------- DATE------- -- -----!P/ REVIEWEDBY-------------------------------------------- -- ----------- --- - - -------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------- ------ ----•------------------------ ----- ----- DATE----:-----------:----------------- -------;�------------ Alterations and/or recommendations:--.. - -- � -----_ -.._._--. :+._ ____-``^"`_ ---------------------------------' -rte:�--.-------- , �- -------- -• --1 ----------: ------ ------ - ---- ,- -------------------------------------- ----------------------------------------------------- --------------------------- --•-------------- ------------ ------ FINAL INSPECTION BY:_...-:C".. -« ------------------{-.----------- Date------ ----•-- ---------------- --------------•---- t SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California CIS 9 REVISED 8-�59 3M'3-'63 F.P,CD.