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FOR OFFICE USE: _ APPLICATION -- _ __ - a «� FOR SANITATION PERMIT Permit No. ....... ----------------- ---------------- - -- ------ ----- (Complete in Duplicate) 6 Date Issued -- This_s Permit Expires 1 Year From Date Issued - _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal(the work herein described. This application is made in compliance with County Ordinance No. 549. . f JOB ADDRESS,AND.LOCATION::�; :1 =7 �-=. 3� � ."_ ------.,, , -T�� C��I---------------------------- Owner's Name----- _ ----- - �--------------------------------- - --- -- Phone-- Address-------- ------- -- ------ -------------------------•-•------------•-------------------•-------------------------------• ---------- Contractor's Name------- ------- -tvC--_-1 -------,;;-# -� Trailer Court Motehone.._O Installation will serve:',;Residence' -Apartment House ❑ Commercial ❑ C ❑ ❑ her ❑ Number of living un ts: __L___ Number of bedrooms _ '___ Number of baths : .:_ Lot size __1__f14_-'--_X-/OP4........_____________________ Water Supply: Public system Community system E] !iPrivate ❑ Depth to"Water Table _ ft. r Character of soil to a depth of 3 feet:...Sand ❑ Gravel EA Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe V Hardpan ❑ Previous Application Made: (If yes,date--------------------) N94» New Construction: Yes .X No ❑ FHA/VA: Yes ❑ Nox TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if public seweris available within 200 feet.) Septic Tank: Distance from nearest well_0ONE---Distance from foundation-----1L)..........Ma�t/e�al_f. a_ _-- � No. of compartments-----..-- -.--------Size,X__r_f�_�-----G:-..Liquid depth------'�".�.__------Capacity/RoG- 44 Disposal Field: Distance from nearest well., ..Distance from foundation----1Q'.......-Distance to nearest lot line-_-J7Of �_._.._ { Number of lines--------- Length of each line - _,o-_ ---------------.Width of trench--------- -----__---.-- - Type of.filt& material--S j�_X_Depth of filter material------- —e----_._Total length_-_______-_-._� Seep ge Pit.- Distance to nearest well__A1PVV----Distance from foundation----_-0........Distance to nearest lot line---4..--... .-.00 Number of pits------ —_---------Lining material__6�A1?4P 4ize: Diameter.-.--- Depth----------2__,�................ 00 Cesspool: Distance from nearest well-___-_-__-_.._-Distance from foundation--------------------Lining material-------------------------------------- J 171Si7e: Diameter--------------------------------------Depth-------------------------------- - -----------------Liquid Capacity----------------------------gals. !� Privy: Distance from nearest we1L------------------------------------------------Distance from nearest building------------------------------..-.--__-.-. ❑ Distance to nearest lot line------------------------------------,---------------------------------- -------------------------------------------------------------------- Remodeling and/or repairing (describe)------------- --- -- - - ----- ---0----------------------------------- O --------------------------------------------------------------------------------------------------------------------------------------------------------/-----------------------------------------=----------------------- f- - ------------------------------------------------------------------------------------------------•-------------------------------------------....-•---------------------------------------------------------------------- ------------------------------------- -------------------------------------------------------------------------•--------------------------------------------------------------------------------- --------- 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)..._____.______. ��= �jOirand/or Contractor) ----- --- -- ------- -- --------- -- - -------------------------------------------------------- -- By------------ ----F- -- ---------------------------------------------------(Tittle)---- ---------- ----------- (Plot plan, showing size of to}, locati of system in relation to wellsbuildings, etc., can be,placed on reverse side). ' ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------c k } '---------------- DATE----I I - ------------- REVIEWEDBY--------------------------------------- ----------------------------- ----------- DATE BUILDINGPERMIT ISSUED-------------------:---------------- ----------------------------- --------- DATE--------------------3.-------------------------------------- ons and/or recommendations: lL? �-�'�' -------� ------- e, �tZ �-------- •--------------------------•- / i--- ----------j-------------------------- ------- Alterations Z� -------------------- ----------------------------=----•-------------------•-- •---------------------------------- ---------•------ -----------.------------------------------------------------------------------------------------------------- ------------------------------------- ------- --------------------------------------------.._-------------------: a F .. FINAL INSPECTION BY: ----- ------------------ Date.... ------1 h2,_: 1 ------------------- --------- 16 SAN JOAQUIN LOCAL'HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,Callfornia Lodi,California Manteca,California Tracy,California [ r5 9 REVISED 8-59 3M 3-•63 F.F.CQ. /