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FORF�E USE:-- SE: _.___.__._.. � � APPLICATION FOR SANITATION PERMIT Permit No. 6. _.- ------- -------------------- ------ (Complete in Duplicate) �� This Permit Expires 1 Year From Date Issued Date Issued __ �. i -- p 0 8'7-- l(0 --d - permit to construct an Application is hereby made to the San Joaquin Local Health District fora d install the work Urein ndescry e This applicatio .rs made, with County Ordinance�la. 549. �� L,L/Q • fid , ; // JOB ADDRESS AND LOCATION.:: i_-____� - -_ U''A'L L .4e,4 G � /. Owner's Name- l�--------•----'2Q.6-�------------•----••---------•------------------------- - ------ Phone.---------------------•------------ Address g` U ---------------------- j' p Contractor's Name---�'• `-"�---`-s=--�= ----- ------- Phone---------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___.1_ Number of bedrooms ___3._ Number of baths _�__-_ Lot size----��A__I��_�� ©�� -- ------- Water Supply: Public system ❑ .Community system ❑ Private [ 'Depth to Water Table __6D ft hic G Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe [Hardpan [j - 4 - Previous Application Made: (If yes,date-------------- --) No- New Construction: Yes Va,--No ❑ PHA/VA: Yes nr�_No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200.feet.) �4_emw Septic Tank: Distance from nearest well__�`_Io_______Distance from foundation_lD______________Material__' ____________._____________.___._.__ ._. �� q L"[ No. of compartments___ .___Size.___'3__._:_____`�____._._:_Li uid depth-----------_______________Capacity.: aPd'� Disposal. :Fie Distance from nearest well__`4-_.0 ..... Distance from foundation---- _-----r------ Distance to nearest -st lot e '�_____ __________ Number of lines__ __------------------------Length feah-lle___ Width of trench-_ -f-R-'_____________-_{ ------ Type-of fter matena. -____----_Depth of,flter.mafersal_��-__________.Total length____�Y_ Seepage Pit: Distance to nearest well._'/O°..............Distanc,g�--f�jjom foundation--!�..............Distance to nearest lot line-_` --------- Number of-pits____:-k------------Lining materiaL__l&t�-------Size: Diameter._33.`__ Depth_...-LJ__._-______.__�____ i Cesspool: Distance from nearest well-----------------Distance from foundation_.__---------:_____.Lining material__..---_____:___ _.___________ ❑ Size: Diameter Dept h ----------------------- -----------------Liquid Capacity--.-------------------------gals. Privy:' Distance from nearest well------ ------------ -----------------------Distance from nearest.building----------------------------------------. .� ❑ Distance to.nearest lot line.0---- -- ---------------- . ` - --------------------------- ' .; Remodeling and/or repairing (describe):------------------------- --------------- ---•---------- -------------------------------------------------------------------------------------------------- - Ill -------------------•---•--------------------------------------- --------------- -----------------------=----•----------------------------------------------------- ---=---------------------------------- - ----------------------------------- - ----•--------------------------------------------- I ---------------- - u .. I hereby certify that~I have prepared this applic tion and that the work will be done in accordance with San Joaquin County _ a ordinances, State laws, and rules and regulat' s o he San Joaquin Local Health District. (Signed) `------------------ ---------- ---- - -- - ----- ---------- -------------f----------------------------------------------.(Owner and/or Contractor) By:----------------------------------------------------- ---------------------- ----------------------------------------------------(Title)--------------------------------: ----- -- .... - (Plot plan, showing size of lot, location of system in rely ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE O LY 17 i APPLICATION ACCEPTED BY _ - -----=------------ DATE:------ Z -P rp �� REVIEWEDBY----------------------------------------- -------------------------------------------------- ----- --------------------- DATE . BUILDING PERMIT ISSUED-- --------------------------------------------------------------------- ---- ------ DATE---------------------------- ------ ---------- - - -------------- Alterations and/or recommendations:--'�----�.9---tP4--------4 ' ---•--2$-1------------------ -_-- --------- ------------------------------------- --- ----- --- FINAL INSPECTION BY:-----GL ----_-rSAN �`�~r---------- Date------- -- 1-- .. /-----------_ ------------------------------ JOAQUIN LOCAL HEALTH DISTRICT 1601 E Haxelton Ave. 300 Weal Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F.P.CD. r