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� S 3.r � ` 1 '31 17/� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) w Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. iThis application is made in compliance with County Ordin nce No. 549, JOB ADDRESS AND LOCATION:- �.� `-______________ �----------------------- ------------------------------------- Owner s Name----/C��-2l- -�"�"u-�4.•�----- --- -- ---- -------- - ---- --- --- --- ----------- ------- --- ------------------- Address - - - . Address jj��- �- ------ -- --------------- ------- + 1 Contractor's Namef'. "�"� �,/ r -� � ---- r`<------ -x-[� Phone_�i`^ -�. Installafion will serve: Residence [K Apartment House El Commercial El Trailer Court El Motel L] Other E]1 :A `Number of living units: -_-� Number of bedrooms _,i-.7_ Number of baths ---�__ Lot size ----- ! l.-c�1 -�----------------- WaterSupply: Public system Community system ❑ Private ❑ Depth to Water Table-3- rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe N Hardpan ❑ F Previous Application Made: Yes ❑l No, New Construction: Yes ❑ No 0 FHA/VA: Yes ❑ No,K TYPEi OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) f � ' Septic Tank: Distance from nearest well-----------------Distance from foundation------_____-----__-Material------------------------------------- No. of compartments----------- --------------Size. •-----------------------Liquid depth--------=------- ---------Capacity Disposal Wield: Distance'from'nea�esf'well '"-_ ::�Distance from foundatio`n----_______ "Disfance fo nearest lot line----------------- Number of Iines-----------------------------------Length of each line-------------t---------------Width of.trench----------------------------------- ..4 {/ Type of filter material--------------- -___Depth of filter material------------ ._Total length_---_--___--___----__--__--------- _ _ Seepage Pit: Distance to nearest well._5��, f':r..- -Distance fro-m fo�u dation---'l _..Distance to nearest lot fine__ Num6br of pits......... _ gmaterial ✓ - Size: Diameter__c.,,3!!_______.Depth---_ 755 ___---- r p ------------Linin --- ----- - -- F Cesspool: Distance from nearest well-----------------Distance from foundation----------------------Lining mater•ial----_-____--------_.----___-----_-_--. Size: Diameter--------------------------------------DePt(-.------------------- -------------r -Liquid Capacity- --------------------------gals. 'Privy: Distance from nearest well-------------------____--__-----.-.---_---_____Distance ifromfnearest building-------,-----------_. ❑ r Distance to nearest lot line--------- -----------------------= - --- •---------------------�'---- ------------------------ -- -----------�"----------- i i Remodelin and or re airin describe :--------- �ce. -- ' .. J ---- Remodeling P I g II ) -----•--- ---------------------------------------------------------------- - --------------------------------------------------------------------------------------------------- -------=--=---•------------------------- ----------------------------------- - � 1 i 4 t -*' I hereby certify'fhaf 'f have p pare'd_6 application and 4liat-46-work'—will be-'don e in accordance-with San Joaquin County ordinances, Sfate laws, /,�indrles and quin Local Health District. Owner /r. and/or /or Contra(Signed:}._ aoctor) By:._ r (Title) ------------- (Plot'plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse sic%. t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- . s . - - ------------------ DATE------------------------------------- 'w REVIEWED BY------------------------ -- - - DATE f BUILDING PERMIT ISSUED------------- "" - DATE_= ------------------------- `� -- ----------- Alterations recommendations:_-.-_/---- --' a,`, r ------------ •- ----- ------ -- ------- -- ---- .-- -- - _• ------- -----`------ ' -' 7 ------ -- - ---.�+ - • -- -- ------- ------ ------------------------------------------------------------- :; ---- ---------------------------- ------------------------------------------------------------------------------- • tea. • FINAL INSPECTION BY:. Date------- -_`_- -- - e - ----------------------- -------------- r SAN JOAQUIN LOCAL HEALTH-DISTRICT �� E 130 South American Street 1 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street l Stockton, California"`-'r-" -7 'Lodi, California Manteca, California Tracy, California ES-4-2M . Revised 1-57;FRCO.