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FOR OFFICE USE: - --- ----------------------------------- ------------------------------------------------------.. - -------- ---- APPLICATION FOR SANITATION PERMIT Permit No. ----- -- --------- ------------- -_ [Complete in Duplicate) pate issued - -`_ .. - .11:-----`-----`S _________________ This Permit Expires 1 Year From 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. _rfr-179E�:_' JOB ADDRESS A D.LOCATION�,P_..X-� -F ,"v j--------- tf --"----•------- e Owner's Nam _ -F. __.�_..-•--------•- -----•• -----•--------•------ ----- -- ------------------------ -------- Phone----------------------------------- .4 1 _ ------------ - Address � --------------- _ �:.._._ --• - ---- Contractor's Name._ f cJ►�3�.c i , - /``t =. --------------------------------------- Phone----------------------------------- v Installation ----•----------•------- - Installation will serve: (Residence Apartment House ❑ Commercial ❑ Trailer ourt ❑ Motel ,] Other ❑ Number of living units: _,C.___ Number of bedrooms_._ Number o baths __._____ Lat size __________________________ Wafer Supply: Public system E] Community system E] Private Dept Water Table -------- ft. E]Character of soil to a depth of 3 feet: Sand Gravel'b Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------- -1 No ❑>' New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS;- a (No septic tank or cesspool permitted if public sewer-is available within 200 feet.)- ' I - �.. t Septic ank: Distance from nearest,weli ___.______.�Distancl from foundation_/V___ ------Material--- of compartments._________`!�-11_ISize_. __. `Liquid depth---- ____ �_ -------- No. ' - p Y Dispas 'Field: Distance from nes rest well,,'_" t�Distarice frorritfoundlation---/Cl_p._-_-- Distance to nearest lot line-5 -------- ,� Number of cines__!__ -- Len th-`.of each line- __ g . [ _-3"�-�'F-x= l/idth of trench-- 2 t ------------------------„r� r,> 1 � I: e, r T e of filter material_________f1 _t_ __..__�De fh o€ filters maternal____.f Total length____ Yp „ ._ _ p : ------ Seepage Pit: distance to nearest well_____________________aDistance fromFfoundation-------------------.Distance to nearest lot line__________.:__.._ ❑ Number of pits--_------------------Lining material-_N _J---------Size: Diameter------------------------Depth------.__.------------------ Cesspool: Distance from nearest well-----------------Distance fro�moundation.........__.__._._.Lining material--------.----------------------- .___.- ❑ Size: Diameter--_-•------------------------------...Dept h------------ -------------------------- --------Liquid Capacity----------------------------gals. Privy: .Distance fromnearest well------------------------------------------------- from nearest building------------------------------- ❑ Distance to nearestilot line-------•-- --------------------------------------------------•------- ------------ ----------- .......... ------------------- Remo'eling and/or repairing (descr;be)i---- ---------------- --------------- -•-------------------------•----- -------------------------------------------------------- --------- --------------------------------------------------- ------------------------------------------------------------------------------------------- ------------------ - ------- ----------------------------------------- l ' - --------- -------------------------------------------------------'---------------------------------------:-------------------------------------------•---•--------------------------------------------------------------- f ereby 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. - (Signed)------------------------ Y --------- - -- . •-- --------------------------------------- • - ------ �nd/or Contractor] By: -- C �'• `; ! ----- — -J -- ------------------------ ...Title)_-.= -------------------------------------------------- -(Plot --' -- (Plot plan, showing size of lot;:,location of system in relation t wells buildings, etc., can be placed on reverse side). ` . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYE_______ ---______ DATE__./1__�!K"4�_J-.--------------------------------- REVIEWED BY---- =-----------------) ------Ir ----- DATE----------------------------- - BUILDINGPERMIT,ISSUED_!- --------------- -----------------------------•---------------------------------------- DATE------ ------------------------------------ Alterations ----------------------------------Alterations and/or recommendations:------------------------------------------------------------------------------------------------.------------------------•---------------••------------------- ------------------------------------------------=-•------------------------ - ----------------=---------------------------------------------------- ------------------------------------------------------------- = •-------------•-------•--------- ------ ---------- -------- ------------------------------------------------------------------------------------------------------------------------------- _ ----------=----------------- -----• --° -------------- --------• --_•-----------------••-------------------•--•--•------••-----•--•--•--------------------••-- ---------- - ------------------• �.3 FLNAL INSPECTION BY:..1J � �°' t ----- - --.1. Date-r l _ 7- ” . i _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Mantecar California Tracy,California E5 9 REVISED a-59 3m 3-'63 i.P.CO.