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�F �FFICE USE: r _ c �� APPLICATION FOR SANITATION PERMIT Permit No. ------------•------------------- ------ (Complete in Duplicate) �J r/ Date Issued .! -_�_3/1 y ---------------'--------'-------------'--'----"--- This Permit Expires 1 Year From Date issued Z —f50-0Z_ / 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 compliant ith County Ordinance No. 549. / - JOB ADDRESS A ATI - -- -- -------- - ----------------------------------- L��` �$ ame ' ---------- Phone. _----_Owners N -••- E --•----------•---------------- -------------------------------------------- Address----------- J v ----//-- --- -- Contractor's Name._.-- - -- --------- -• ------•----------------------------------•--------•----------------------------•-----------'•-•------------- Phone- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _L____ Number of bedrooms __X__ Number of baths j�Z. Lot size ___Z ------ Water Supply: Public system ❑ Community system ❑ Private'o Depth to Water TablV..:tr ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan ❑ Previous Application Made: (If yes,date___________________) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F &dl Septic Tank: Distance from nearest well_5_d__F---Distanceq from foundation__-J-;:�-------Material----P ^______________________F_______. No. of com artmonts- SizeyZ>_K!�._ ..._ ___Liquid depth____.--._.------- ---Capacity._/,,709__ __ Disposal Field: Distance from neare t well._.SQ__.._Distance from foundation.. ______.Distance to nearest lot Number of lines.--,.3_. -_ __ Length of each line`Q�=� _/ � idth of trench______ _ :_____:__� of filter mater a]- _ Depth of filter material__._, �-_ g -- -------Total len th------- ------------------- Type -- Seepage Pit: Distance to nearest well----------------------Distance from foundation________-_-_....___.Distance to nearest lot line-------'._______°_ C ❑ Number of pits----------------------Lining material---------------------- Size: Diameter-----------------------Depth__--- -------------------- G Cesspool: Distance from nearest well-----------------Distance-from-foundat ion---------------------.Lining material-------------------------r---;_- Size: Diameter------- - De th-- f } Li uid Ca acit ---- gals. ❑ p q p y----------------------- 9 Privy: Distance from nearest well--------------------------------------------- ---Distance-from nearest building:,_________________-___________.___.. ❑ Distance to nearest lot line--- ------------------------------------------------------------------ --------------------------------=------------------------------------ 4- Remodelingand/or repairing (describe) '-'--- -- --------------------------------------- -•------------------------------------------------------------•------------------------- - -------------------•------------------------- --------=-----------------------•------------------------------•----------------------- •------------------------------- - •--------------------------- d ------•------------t ---` a --------------------------------------------------- t lF --------------------_-- ------------------------------------------------------------------------------------------------------------------------ _ ::---------------------------------------------------------------'------ I hereby certify that I have prepared this application'and that the work will be done in accordance with San Joaquin County ordinances a e laws, 11 rules and regulations of the San Joaquin Local Health District. y M a (Signed)--- ------------------------------------ - -- --------- ------- ----- --- ---- --- --------------- -------------- er and/or Contractor)_ Sy:---------------------------------------------- --- ----------- --------- -------- --------------(Title)---- E w (Plot plan, showing size of lot, location of system in relation to Is, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ----- - ---�5------------------ } DATE------7 .,�, _11 --- REVIEWEDBY------'------------------------------------------------- --------------- -------------------------------------- DATE •------------- -------------------------�- BUILDINGPERMIT ISSUED------------- -- ------------------------- ---------------------------------- ---------------- DATE------------------- = - Alterations and/or recommendations:.___ _..- . ._. .__ ------------------------------•---•-------------------------------•-----'------------------------------ --- -----------------------••------' I.._ ------------- ---------------------------------------------I-------------------------------------------------------- ----------------------••------------------------ -------------•------••--------------------------------------- 1 ----------- -- ---- -------------------------------------------------•--- ' -- ------------------------------------------------------- ------'---------------------------------------------------------------------------- FINAL INSPECTION BY:__L.:.-'-- - - ----------'----------_---'- --------- Date- C'�--------- -- --------•---------------- .. 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street i ..•245 West 9th Street Stoektonr California • Lodir California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.CD.