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FO OFF CE USE: � . ------------- ----�--- __-: �t-? - __________________�,'r-.34-- 7 ' APPLICATION;-FOR4SANITATION PERMIT Permit No. . .74� ------------------ ----- ---------------------------------- r._.,.. .(Complete in Duplicate) `Date lssued -------------------------------------______._..__-_: t.This Permit Expires 1 Year From Date Issued Application is hereby made to fhe 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. JOB ADDRESS AND LOCATION--- -- V -� Owner's Name . - = =-------------- ---------------- ------ Phone------------------------------------ Address3 - -----� -------- ------------------------------------------------------- , Contractor's Name----- '�' Iy-W-Z�;------ ------------------------------------ Phone---.------------------------- Installation --•---- Installation will serve: Residence b`—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .Number of living units: - :_"__-Number of bedrooms.__-_ Number of baths /______ Lot size 07dX/a-0------------------------------------ Water-Supply: ________________._____-__________Water Supply: Public Isystem-[Community system•E Private ❑ Depth to Water Table _- Kft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[A FTardpan ❑ Previous Application Made: ;(If yes,date--------------------) No E3 New Construction: Yes ❑ No El--- HA/VA: Yes ❑ No 0— TYPE OF INSTALLATION AND SPECIFICATIONS: --; (No septic tank or cesspool perrni#ed if public sewer is available within 200 feet.) Septic nk:^ Distance from nearest well-----..-:-------:Distance from foundation__._____--________-Material___________.______.__..___________.._____.____- Ej. No. of compartments-------------------------Size--------------------------------Liquid depth---- --------------- -----Capacity----------------------- Dispo } ie) :FDistance from nearest well---_~____.._.Distance from foundation.--L {_____.__.Distance to nearest lot line.-- ---__-..__. Number of lines______ g - --- Length of each line---`-`�C�-------------------Width of french---------�--.------- ------------- Type of filter materiae-G-!S__------'Depth of filter material--/_r__�->___--._Total .length-----! --`-------------------------- Seepage Pit. -------------------SeepagePit: Distance`to nearest.well------- ----------Distan%4rom foundation---/!I_----------Distance to nearest lot line--------- Number of pits----L--------------Lining material_f, p_t_l.........Size: Diameter._.-s3.-!Z- Depth....!!Z- -- -------------- Cesspool: Distance'rfrom nearest well-----------------Distance from foundation--------------------Lining material--------------------------.-_._-_____ El Size: "Diameter--------------------------------------Depth_------------- --------------------------------------Liquid Capacity------- -----•-gals. m Privy: Distance„from nearest well-----------------------------------------------_Distance from nearest building-------------------- ❑ Distance to nearest lot hne---------------------------------- ---- ------------------------------------------------------------------------------ -------- ----------- 4C Remodelingand/or repairing fdescribe7----------------------------------------------------------------------------------------------------------------------------------•------------------------ -- -- --------------------.------------------------------------------------------------------- ------------------------------------------- --------------------------------------------------- -------- ----------------------------=--------------------------------------------------------••--------------------------------------------------------------------------------------------------------------------------- ------•-----------r----------•----------------------------- ---------------•-------------------------------------------- -------------------------- --------------------------------------------------------------- - 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,Joa uin Local Health District. (Signed)=-----•------------- • --- ----------- ----------------------------------------------(OWp�for Contractor) By' (Title) G, (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 4 APPLICATION ACCEPTED BY- --- _--------------------------------------- DATE---- 7� REVIEWEDBY------------------------ ------------------ - ---------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------- ----- --------------------------- �� -------------------- tDATE----------------------------- ---------------------•-------- Alterations and/or recommendations:--_____ _ . 3` !` -T__ ` f es= --c' --�._____ �.�_�__ -------------------- -----•--------------- --------------------------- ---------------------------------------------------------- ----------------------- -- ------------------------------•------------------------------------------------------- ----------------------------------------------------•--- ------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:___._ �______ Date.....__�w - - rNJOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 30Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 15-59 3fM 3•'63 F.P.DD.