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rvK UN-K-t Usk: 0 - . `� ----------- ------ APPLICATION FOR SANITATION PERMIT Permit No. ._1a.G ----------------------------------------------- --------- (Complete in Duplicate) �. ---------------- ----- ---- ---- ----- _-- This Permit Date Issued l-a Ex fres 1 Year From Date Issued Application is herebymade to the San Joaquin Local Health District for a permit t tocnstruct and ins+all the work herein described. This application is made in compliance with County Ordinance No. 549, JOS ADDRESS AND LOCATION -D.f"A-k--I------•5T' -`57J� Owner's Name--- •-- -•--- -------- _ i------ ------- ------------------------ ------- Phone._ _ _r�' r 7 Address----------------- -�. � I ------ -- -------------------- Contractor's Name__ _______ ----•----- --------------• ------ Phone._�� _— l_a___�__� Installation will serve: Residence f5�' Apartment House ❑ Commercial �.— ❑ Trailer Court E] Motel [I Other ElNumber of living units: ___ Number of bedrooms - .- Number of baths _-"'7�tot size F I Water Supply: Public>system I1 Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay V y ❑ Adobe JR Hardpan ❑ Previous Application Made: {If yes,date-__`. „.__--:.°--_-} No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS, r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material________-____-._ El No. of compartments-- -------- Size - Li_id�depth__ Capacity----------------------- Disposal Field: Distance from nearest welt_________________Distance from foundation to nearest lot line___________-___.. ., ❑ Number of lines------------------------! _------Length of�each.line---=-':-------------------- :Width of trench------------------------ Type of filter material_-__.---'-W_.! '-_`xpepth:of�filter material_,____________________Total length__-_--__________---__-- t4. �. 7- Seepage r Distance to nearest well___:_ �'L !^-4.__Distance from foundation_.-_ _"_ ., 9� � _.�_-__ Distance to nearest lot line____s.� } Number of pits'__-_-I---___.--_'""Linin matenal__St--� Size: piameter___r ,- ! 3 3 j1 ..Depth -J� 1lj! Cesspool: Distance from nearest well______---_ p __Distance from ---_li _ Lining material_____________________ _____- 111 El Size: Diameter-3 Depth__ - ----------------------------------------Liquid. Capacity ---- gals. t --------- Privy: Distance from nearest,weiL -__ _Distance from earest buildin ' n d.�.. 9 -----E--- .. L ' ❑ Distance to nearest lot line'_.__------------------- ------ -- i Remodeling and/or repairing (describe):___ . t •-----------•------------------------------------ # F -------------- ------------ � ,nom. - - -----:----- -- i----------------- ,. i f - , ---------------------'------------•-----------------•------------------------------------- ' } -----------------------------•- ------------ ------------------------- ---------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in ccordance with San Joaquin County ordinances, Sofa , laws, and rules andfregulations of the San Joaquin Local Health District. t 5i ned . I I g ) - -- ----- -- --- __ � - t - - ner and/or Contractor) BY ------" ----- ----- •------- ------- ---------------------'-=--------- ----------(Title).',--- (Plot plan,.showing size of lot, location:of ystem in relation to.wells buildings, etc., can be laced on reverse side). t. q t S t FOR DEPARTMENT USE ONLY . t APPLICATION ACCEPTED'BY-.._-__ l -- --------------•---------------.DATE-- �p / t REVIEWED BY----------- ----------- -- - - -- � - # � ., � - �--- -----•----- �---- --- BUILDING PERMIT ISSUED- 7�'r DATE -- ----------------------- ....................... - - DATA = s Alterations and/or recommendations:__-_ - � d 9 -- - - -----------'-----� ' - -- f- L.a _________________________________________________ t ------------- ------- - ------------------ - ------- ---------- ----------------- ---- ! FINAL INSPECTION BY:_ ------- a ' Date_. d f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Cc llfornia Lodi,California Manteca,Cafifornia Tracy,California E5 9 REVISED 8-$9 3M 3-•63 F.P.CO.