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FOROFFICE USE; - _a..:'.. '._..__-.-.-.---- APPLICATION FOR SANITATION PERMIT Permit No. __l_-.7_.._.... --------------------- (Complete in Duplicate) --- ------------------ This Permit Expires 1 Year From Date Issued Date Issued _./t �_r� Application is hereby made to the 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------- .......5--14-R51- � _ _ -------------------------•------------ Owner's NameC - - Phone.t` r^S•- - Address------------------_4 `-S-A-yyx- Contractor's Name--------. { -0 ------------------------------ -_ ••}---N------C----------•------------------- -----------------.. .--------------------.-. Phone---`--1--6---�•----�---�-----i-- o -- Installation will serve: Residence P Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1----- Number of bedrooms _,3--- Number of baths ---I---- Lot size ----------------------- Water Supply: Public system CR Community system [IPrivate ❑ Depth to Water Table _1 P___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe 10 Hardpan ❑ Previous Application Made: llf yes,date____________________) No o New Construction: Yes ❑ No �n FHA/VA: Yes ❑ No 19 TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) ..�. Septic Tank- Distance from nearest well-----------------Distance from foundation--------------------Material----__--__--.-.------..-..--.---__-_.-.-_-----. No. of compartments-------------------------Size--------•-----------------------Liquid depth--------------------------Capacity----------------------- Disposal Fie d: Distance from nearest well-.No .0 Distance from foundation----.i--Q---------Distance to nearest lot line---s6........... Number of lines------------I---------------- -----Length'of each line---------YQ---------------Width of trench---------- --`t_`:.------------ Cra�1 Type of filter materiaL_S_'__O-PGC__Depth of filter material_.-__'_-_}__� __.....Total length------------/A------__--------------- Seepage ___________Seepage Pit: Distance to nearest well----e OZV6E__Distance from foundation------/_P._------Distance to nearest lot line---,5. 1% d Number of pits__.----t--------------Lining material__S' .:Size: Diameter_____. 3-_2_6!Depth........2 ---------- - Q f r Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--.-...-___--__________._-----------. ❑ Size: Diameter------------ ------ -------Depth---------------------------------- -----------------Liquid Capacity---------------------------gals, tA Privy: Distance from nearest well------------------------------------------------Distance from nearest building---------------------------------- -. ❑ Distance to nearest lot line-- ---/--------=------------------------------------------------------ I /ti Remodeling and/or repairing (describe):---- 964---------11-0--------- ----------- --------- --------•-- -- S YS� - =- • •------------------------------------------------------------------------------••------------------------ ----- 1n ----------- ----------------------------------'-------------------------------------------------------------------------------------•-------------------------------- -fes ------------------------------------------------------------•--------------- ----------- ------------------------------------------------------------------------------------------------------------------------------------ Q 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. --------- ' ------ ------- ---------------------------------------------------------- (Signed)------------61<_1 _-___Owner and/or Contractor) By.---- �'`'4----- - -------------- ------------------------- ------- -----------------------------(Title)------ (Plot pian, showing size of lot, locatio of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ------- ----------------------- DATE-------- REVIEWED BY-------- ----------------------- ---,--- - - -- ------------------------------------ ----- DATE------ BUILDING PERMIT ISSUED-------------------------------------------------------------- -------------- DATEr------------------------------------ Alterations and or recommendations:............ ... .. �'f � � ��-�— _----,�.-f-; t��'�-��--4w---J� / �� - .1f� --cam` --------------•---- ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ F . s FINAL INSPECTION BY: -------- ----------- ----------------------------- - Date-------- � S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 3 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVISED B—S9 2M 3-'63 F.F.CD.