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FOR OFFICE USE: ------------------ F --� M-, APPL1CAtEQN FOR SANITATION PERMIT Permit No. ..:/ -3 f - ------------ -- ----- - - • (Complete in Duplicate) -------------------- ----------------- --- This Permit Expires 1 Year From Date Issued Date issued ---f�041�i Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap lication.is- nada in .compliance_wifh County Ordinance No. 549, JOB ADDRESS AND (LOCATION �_f - ----_j- D aF2�- - -------------------------------------------------------- -�----- --Z-------- ----------•-- Owner's Name---- ------- � Phone sAddress-_._ _ �- I Contractor =� Contractor's Name --- ------------ --�---- .. l�Q- '�'�"fZ/ -� �: ...� y��•'_�.a'._.,T_ ' ---- one f' Installation will serve: Residence. Apartment House ❑ Commercial [] Trailer Court Motel ❑ Other ❑ I Number of living units: _/-_"- Number of bedrooms-� �- -------- Number of baths __/__- Lot size � / Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table --� ft. Characfeir-of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ Sand Loam Clay Loam ; Y ❑ y ,�lay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote._____.- ...........) :No ❑ New Construction: Yes-E] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well__' C7� -_--_-Distance/from foundation_--�- materialff -- - -- -- ------ ----- _ � No. ofcompartments-------?�- -",------Size-Z--�C--_�__X_=I�Tiquid depth------ --�f- ------. Capacity 7.E-.0 "D Disposal ie1d: Qistance from nearest well / ,n - ._ -0---- Distance from foundation.__/ ___-.Distance to nearest lot line---X_- - --- Number of lines-2_--"---_:. --------------Length of each line--------7: Type of filter mateial.. � �___. _--Width of french- ----.v�--r - ,o� _ epofer 'Materia-----_/ __ -/ Seepage Pi+;r .,Distance to nearest well- l l h-__--"" "Distance from 'Foundation----- j �� l _ Qis#air� to nearest lot line Number of pits--- - -_?-- -----Lining material-_,��_Q=- Size: Diameter__-c�_----------.Depth----- --------------- 9 - F - Cesspool: : Distance from nearest well----------------Distance from foundation----------.--------Lining : = material----__---_--_------_-_❑ Size: Diameter ----------Depth----------:---------- ------------------------- ---Liquid Caacity-----------------------.-""_------ ---------------- pgals. .Privy= Distance from nearest well___ __ ____________ _bistance from nearest buildin V1%❑ Distance to nearest lot line g------------------------------ ----------- 0 ----------'---' ----------------- ------- Remodeling and/or repairing -{describe)-------------------- - r --- -- ------- -----------------------------------------------------------------------------••_ @ _ .. ---------------q__--_____----__---_ ---------•----•----`-•---------=- i ;-------- ----------- �"`------ --------------- --- _____ __ _ , 1 hereby ertify th` I have prepare application and that the work will be done in accordance with San Joaquin County ordinances, tate aws d'r d. r s-of tthe�Sa Jo i Local Health District. (Signed),-- - --- •-- •--- ------ -------- -------------------------- ------------------------ Owner and/or Contractor) By:------------ - l �., --------------- -------- ------- --------------------- • ---------- (Title) (Plot plan. showing size of lot, location of system_in- lation to wells,„buildings, etc., can be placed on reverse side). _ FOR DEPARTMENT-USE ONLY { APPLICATION ACCEPTED BY...... �? yet ---------------------------- DATEsr- ' ----- REVIEWED BY------------ - ----------- -------------------------- DATE.- BUILDING PERMIT ISSUED ' --_ DATE : -------- _ Alterations and or recommendations:. ----. - - -_ t - -----•--`------------------------------' d ---.------ �. -------.".-------'- -------_1-------------- FINAL INSPECTION BY:- - --- Date- , ----- -- rNJOAQUIN LOCAL HEALTH DISTRICT 1401 E.ffaxelton Ave. 300 West Oak Street 5 1r 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California P Manteca,California Tracy,California C9 9 REVISED 8-59 3M 3•'63 F.P.0 p,