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F R FFICE USE: e -- - - -------------- --- -------- -----� APPLICATION FOR SANITATION PERMIT Permit No. . ... 71 i' --------- --------------------------- --------.---- w f (Complete in Duplicate) . This permit Expires 1 Year From Date Issued Date' issued _ 1l.G yp Application is hereby rrlade to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made incompliance . ith County Ordinance No. 549. jr,5-�7- �_ x1 2b d�C-2oo� 3^7 JOB ADDRESS AND LOCA IONe _ , t T -------- ---- '-C1 N Owner's Name- - ------ '- r -------•-- Phone_ Address-----•------------------- - ------------ --------- ------ ----------- _ -------------------------------------- --------- /Contractor's Name-------- ----------- -� � �� -�� -�--------------•------•- Phon � f�°��/ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Otherx Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot.size --------------- Water Supply: Pub€ic>.system 9 Communitysystem t f y [] Private ❑ Depth to Water Table �--�ft. � Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (It yes date----------------- ___" __ .- _-.___) No ❑ New Construction: Yesr,' No ❑ FHA/VA: Yes ❑ No ❑ j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 41-e4 r• //-�Septic Tank: Distance from nearest weII G1'Distance from f6undaflon_/ 4!_:)______ Material__ _ _ t No. of compartments-----�-_------------- 5izey��_ s- .Liquid depth ---_Capacity '00 � Disposal Field: Distance from nearest well)�7l_._Distance from foundation.-A-.0 Distance to nearest lot line-- -------------- Width _I--_•-_ Number of lines"__.__-1___--_-____�. Len th of each line_1G?,4_' 17Width of french.-_ .� �., g ,..,..Type of filter material- "�_ J -_---_ _:-Depth of filter material-/_9_ ---- --" _---Total length ----��-�j-•'---. Seepage Pit: Distance to nearest well3 ---'Distance om foundation-1f•_"•.Distance to nearest lot line_:_ 1_ i Number of pifs-----`-------------Lining maferial_ rOf ------Size: Diameter_` Depth .R �'' J -- ------ ---- De to----- -- --�----- •--------- Cesspool: Distance from nearest weft_______________Distance from foundation-------------------.Lining material----------_-_-_________-_------_____, ❑ Size: Diameter------------------------ ---- ------Depth----- ----- --------------- - ------ ._Liquid Capacity_G p tY :-------------- - `---gals. Privy: Distance from .nearest well------_____________�`_-_.___-__-___----_-.-_Distance from nearest building -------------------- ❑ Distance to nearest lot line________________ _____"--_-------------------- -----------�- Remodeling and/or repairing (describe):"______.-_-__-___-_ I -----=---------- ------------------------------------------=---------- 1 ---------------•------------------------------ ---- -------------------- --•-----------•--------------- ------------------------------`------------------•---- -- C I hereby Certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. Stat laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- -- -----------------"--•-.------ weer and/or Contractor] By:--------------------------------------------=--=-=----------------- ---- -------- - i� (Tule . - - _ } - {Plot plan, showing size of lot, location of.system in relation to wells buildings, c., can.be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE � ��= / = ---------------------- REVIEWED E I IS -- E - --------------------------- DATE------------------------------------------------------------- - BUILDING PERMIT ISSUED------------------ ---------------- ---- --- TE------ -----,--------- ------D Alterations and/or recommendations: . �� ..._� a_f _ ---------- ------------ - -----�------------fit ----- ---------------- ------------------------------------------ ----- A --------------------------------- ------------------------ - --------- ------------------------------------------------- FINAL INSPECTION BY:"- -- ----- - ------- ---- ------------------ ------------- Cate--- , � 6' ---------------------- S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave, 3 0 West Oak Street 124 Sycamore Street 205 West 9th Sheet Stockton,California Lodi,California Manteca,California 7racyr California E5 9 REVISED 9.59 3M 3-'63 F.P.c(3.