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FOR OFFICE USE: -------------------------- ------ Permit No. APPLICATION FOR SANITATION PERMIT ' --d- -•- ------- --- - G --------.- (Complete in Duplicate) --- ------------- - Date Issued ------- _ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein descri This application is made in compliance with County Ordinance No. 549. E U�•'•'----- =�- ^-- -•- �t`'.-E ^-- J�i`---- 417/LP -.�G>? , -'fir- .--- --•---j------- JOB ADDRESS ND LOCATION3I�- - -. -- -- �T Owner's Name Phone -•- Address-------- --- 41-4-Y------------ .. Contractor's Name----------- = -- --------------------------------------------------------- Phone Installation will serve: Residence [�/ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ._ Number of baths _ Lot size _- _b - 4---------------------------- Number of living units: _.�1- Number of bedrooms _,� -'- Water Supply: Public system ❑ Community system ❑ Private ZDepth to Water Table 7b- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel El , Sandy Loam ❑ Clay Loam E] Clay 11 E] Adobe 0 Hardpan Previous Application Made: (If yes,date-------- -----------1 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.) earest well_________________Distance from foundation__.__________-_____.Material____________-__.__.-_______-__-___.__.._______. Septic Tank: Distance from` ❑ No. of compartments---------- --- ------Size--------------------------------Liquid depth---------------------- ---Capacity-------------- --`---- 1foundation... r ' Dispos Field: Distance from nearest well- '��'.___..._Distance from foundation..___f P--------.Distance to nearest lot line____�r________.0 of lines-----------I-------------------- Length of each line-------„ B__ ..... ---.Width of trench-._.__0'__-------------------- Number -- 7 ` Type of filter. material_ . Depth of filter materialf_ _`-----Total length__.___�A__--______________________ tb .� Seepa Pit: Distance to nearest well-----1!!8_______Distance fro_m`foundation___J_L2_____---_.�istanc�e to nearest lot line___v________._. ->+ Number of pits---------/------------Lining material/4_V_�____-Size: Diameter--- -- -----------Depth-- ------------------- Cesspool: Distance from nearest well-----_-----------Distance from foundation---_-____--------Lining material---------------________._____-_--- ❑ Size: Diameter--------------------- Depth----------------------------------------------------Liquid Capacity----------------------------gals .�C t Privy: Distance from nearest well_-_----------------------------------------------Distance from nearest building-------------_----------------------------f� ❑ Distance to nearest lot line----------------- --------------------------------•---------------------------------------- Remodeling and/or repairing (describe):---------- - ------------------------------------------------- --------------------------------- ------------------------• -------------------------------•------------------------------- ------------------------------------------------------ - • I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ws, and rules a d regulations of the SanJo uin Local Health District. ordinances, Stat 6 o a / - --------------- ----------------------_- (Bw�rler-and for Contractor) (Signed)------- /]�/� ` - 139 ----hN-f--------- $-6 - Tttle (Plot plan, showing size of lot, location of system to relation t ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY gg l APPLICATION ACCEPTED BY DATE----1 f_-"�3-------------- ----------------- - ------ -- -- -- ---- REVIEWEDBY------------------------------------- - - -------------------------------------------- • DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------ - ------------------------------------ DATE------------------------------------------------------------ Alterations and/or recommendations:--------------- ----------------------- ------------------------------------------------------•-•-----------------------------------------•------------------- - ------------------------------- # ., •----------------------------------•------------------------- --------- .........---------------------------------------------- -------------------------- �.- '�'�'r D FINAL INSPECTION BY:. ----------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California ladi,California Manteca,California Tracy,California ES 9 REVISen 8-59 3M 3-'63 F.R.CO. ,