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P . o oA 61 APPLICATION FOR SANITATION PERMIT Permit No. 3.3.7.. (Complete in Duplicate) &0v 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--------- �--•----1 ------ -------------------------------------------------- /d-C�t ..�� -------- Owner's Name - ------ Phone----••----------------------------- Address------------------- 7 fi , .�✓------- -----------------------------------------•------- Contractor's Name------------------ -------- '-- Phone .. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __S___ Number of bedrooms _ Number of baths __/-__ Lot size -------&d'-----�'��'i.L../-i'-.---------- Water Supply: Public:systemCommunity system [IPrivate ❑ Depth to Water Table Va ft. of Character of soil to a depth K3Iee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ PHA/VA`Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r U Septi Tank: Distance from nearest well_,01j"isf�ance from foundation _____-_Materiali____�/ ---- No. of compartments.......�-_----------Size_---- -- _--Liquid cl pth----- -------------Capacity_-� ---- P9 / -. al Field: Distance from nearest we1L_ EAistance from foundation_,le___________Distance to nearest lo`t�l`rge_ _______. Dispos Number of lines--- ---------______.___.Length of each fine_/-n_-e/___&T----Width of trench_Z2--T:y____________________ Type of filter material___ or _____Depth of filter material___— __._____Total length-_____��__________________`__._ Seep ge Pit: Distance to nearest well----ADA)C_Distance from foundation---./Q ___.Distance to nearest lot line_ _______ Number of pits-------f-------------Lining material----R40.o��, ,� --Size: Diameter---- 3r � ----------.Depth---- ------------------- Cesspool: Distance from nearest well-----------------Distance from foundation__._____________--- Lining material--_____--_-____-_-.____.._____----__. ❑ Size: Diameter--------------------------------- _Depth----------------------------------------------,-----Liquid Capacity-_-------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-;-----------_---------------------------. ❑ Distance to nearest lot line----------------------- --------------------------------------------------------- ---------------------------------------- Remodelingand/or repairing (describe) -- ---------------- ------------------------------------------------------------------- --•-------------------"--------...------------------------- ------------------------------------------------------------------------------------------- --- ----------------------------------------r-------•-------------- -- _--_------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepay '-_application and that the work will be done in accordance with San Joaquin County ordinances, Statens es a regul ns of the San Joaquin Local Health District. - (Owner and/or Contractor) --- (Signed)--------------- ---- - - . Cf� --- - - -------------- By: -------------(Title) (Plot plan, showing size of lot, location o system in relation to IIs, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY nw APPLICATIONACCEPTED BY------ .-- -- --- ---------------------------------------------------------- DATE------------9------'9'- -`---��_5;- ------------ REVIEWEDBY----------------------------------------- ---- - --------------- DATE BUILDINGPERMIT ISSUED.----•----------------------------------------------------------------------------------------------- DATE.------------------------------------------------------------ Alterations and/or recommendations-------------------------------------- --------------------------------•-----------------•----------•-------•--•--------------------------- -------------------------------------------------------------------------------------------------------------- ------- - --- ---- -- - ---- ---------- ----- - - - - _ -------- R FINAL INSPECTION BY:------- _ ..= ' ------ Date ------ --------- -`�2��0 i7 - --- ---------- SAN JOA UIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi,_California Manteca, California Tracy, California E5.9--2M Revised 8-'59 F.P.Co.