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39 OFFICE USE: ,.- =.. APPLICATION FOR SANITATION PERMIT Permit No. ___1_22___ _ ------ ----------------------------- --------------------- (Complete in Duplicate) . / Date Issued ------ --------- ------------ This Permit Expires 1 Year From Date Issued �� o� Application is hereby made-to the San Joaquin Local Health District for a permit to construct and install the work herein described. This aplication ' made in compliance with County Ordinance No. 549. 7 ,J_ JOB ADDRESS AN LOCATION-___--- -' - -----d1X_ �3 __ ---,Irl X 1'CP,--,1 ---� Owner's Name--- .----_ ---------------------------------- ------------------------- Phone------------------------------------ Address-----11/� -- - --- ------------------ ----------------------------------------------- -------------------------------------------------------------- Contcactor's Name________ -•----= '`' -----------------------------------------------------------------=----•-•------------- Phone-_----•-------------.-------•--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Nurriber of living units: _ __ Number of bedrooms --,T- Number of baths _z_ Lot size ------------------••----------- WaQ' Supply, Public system ❑ r Coinmuni+y system ❑ Private 8--Septh to Water Table _AfT Character of soil to a depth of 3 feet: Sand'o Gravel ❑ Sandy Loam ❑ Clay Loam [S"-Clay ❑ Adobe❑ Hardpan ❑ Previous Application- Made: (If yes,date---.____.--___-.__.) No 2'�New Construction: Yes ❑ No 2R101FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / Septic Tank: Distance from nearestwell__ Distance from foundation---/.�___ __._.Mate`ial___ N'��of compartments-----+r_______________Size_ C ._i -- Q____-___Liquid depth____ �._.__.-.-__CapacitY-- ------ Disposal Field: Distance:from neares ,well---90._..._.Distance from foundation__-Z- __Distance to nearest lot Zine__ ___________ Number of lines...... ------_�----..._:---- Length of each line___,'> r--___.---___._.Width of trench.__A-`---------------------- .07 Type of filter material-_ Depth,of filter material---- �� Total length . �p tj SeepageIt: Distance-to nearest well-----1-0a---__Distance from fou dation____ -------- Dista yce to nearest lot line__�.�__-_--- Number of pits----v�_..._--------Lining material_ _Size: Diameter_-.'3___ ....-_-Depth__�2Nr_xo:_154Z-. , Cesspool: Distance from nearest well-________________Distance from foundation--------------.-----Lining material--.-._-_----_____-.__._________._4 ❑ Size: Diameter ._.-------Depth----------------------------------------------------Liquid Capacity---------------------------gals Privy: Disfance from nearest well ___________________-----------------------------Distance from nearest building______________-_---____-______.__..__._. ❑ Distance to nearest.'lot line-------------------------------------------------------------------------------------------------------------------- --- -- Remodeling and/or repairing (describe)--------- ---- ------ 1 � -----------•--,------- ------ ----- --- ------------------------------------------------------------- - --- - -- - - --- -------------47,114-9---- -------------•-----------------------•-------------------- ------=-----------•------------- --------•------------------------------- ------•---------------------------------------------------------------------------------------------- ---------------------- I hereby 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. Si ned4 -----------------------�/or Contractor) By:------------------ ----------------------------------- -- ---- w -----(Title)---- -------_--------- - (Piot plan, showing size of lot, location of sys+em.in relatio o wells, buildings, etc., can be placed on.reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.A ' J � - --- DATE -- --- -------- REVIEWEDBY--------------------------------------------- ------ - --------------------------------------------------------- DATE - l BUILDINGPERMIT ISSUED------------------------------------------------------------------ -------------- ------ PATE------------------------------------------------------------- z Alterations --------------------.-----------------•----- - -- - Alterations and/qr recommend ations________________��'- --L---------- •--------i'--� .... r --------------------- ------------- ---------------------------------------------------------- ----------------------------------•----------------------------------------------------------------------------------------------------- ---------- ------------------------- -------------------- ------------------------------------------------------------------------ ---------------------------------------------------------------------------------- ��_ / FINAL INSPECTION BY: ---------- Date---- ..... -------- --------------------------- rSANJOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 31,4 3•'63 F.P.CD.