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FOR OFFICE USE: -- APPLICATION FOR SANITATION PERMIT Permit No. ..�_��- 3.... .-....... ..... ..... ...................- -- - (Complete in Duplicate) '�,�,�t �}/� This Permit Expires 1 Year From Date Issued G��L�"" Dote Issued ..(� t S Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. T 's application is made in compliance with County Ordinance No. 549. i JOB ADDRESS AND LOCATIOI�jI . . �_nt.P! _. �• .�!!-�_ .."_ ". .1`1__hrrsi.._X !. __....- Owner's Name_.._.._._. ��t1 ----..�.__.. .. Phone.......-.-•........................ Oa3 r7o 7, I ' Address-----------i1j_�.. .... r ....._. •r ,� •-•-- •- ��'ft /- , - _ Contractor's Name........ �r ..�C. /!✓.._ �... .. Phone........ .................. ... . .._.._--•---..._.. ...... :.. Installation will serve: Residence 93/Apartment House ❑ Commercial ❑ Trailer/Court`D Motel ❑ Other ❑ ' Number of living units: ..I... Number of bedrooms -3... Number of baths .�_�._•Lot size .......... ------........_-.-..--... Water Supply: Public system ❑ Community system ❑ Private EJ-;Depth to.Water Table-_._'..--ft., ' 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel Q Sandy Loam ❑ Clay Loam [T�Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----------.........) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No❑ `� TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well-----•-•- .J.L Distance from f undation...JP.__.....--.Material_-..: .................. i No. of compartments.........�.--•-.--..Size--- --14___l�.g_.1�,.5 .Liquid depth......q.................Capaaty___L_�-. Dispos Field: Distance from nearest 11 X61 Distance from foundation..-110-.' ➢istance to nearest lot line.Z._�........ Number of lines__________ ___________________Length of each line.- ____�.._.__...!_. Width of trench.. `' Z..��.. �d b-� W Type of filter material-_... r. -e-_._Depth of filter material....../. ........Total length......g4kP......................... Seepage,Pit: Distance to nearest well-------------.------.-Distance from foundation....................Distance to nearest lot line__.._..-...._....� W El I Number of pits......................Lining material.......................Size: Diameter-----------------------Depth___. ...----------._•--------_--_, Cesspool: i Distance from nearest well.................Distance from foundation....................Lining j material...................................i ❑ Size: Diameter.............. •. --•-- Depth......................................................Liquid Capacity----...,•-• -- . .........gas: Privy: I Distance from nearest well-------------------------------------------------Distance from nearest building............. ........ ❑ Distance to nearest lot line........................ -----•----------•-----------------•----- --- 1 Remodelingland/or repairing (describe):........................... n _.t........................................................ ------------------------------------•---------------------....------------------------------------.....------•-------------------------------------....._..-----------•-----------------...--------------•--•.............. I-�a 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} - -----:---•.......... ... .. ......-•-•---------••-•----•---•--.----- ---------•-----•--•-----..J6wie and/or Contractor) BY:- = ---------------------- -------------------- ---------------------------------------(Title) t (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... . .- 704-----------•----------------------------------- DATE 6 -L ------------------------------- REVIEWEDtBY.................•------------••---•--••-...•...............•-••----------....-----•••---................................. DATE---•--.....-•---.........----------------------------------- BUILDINGHERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE............................................. ............... Alterationsand/or recommendations:.........................................__............................... ...................---------------------------------------------------- .............:.................................•........................................................................--•--------.._...._._...........---..........--••-------•------•--•-----•--------•--------••- ................... .................. --......_...................................................---........----.........................._........................................................................ ..............................•---•----........_.._._..............---•------•---------...--• ... ------------------------_................................................................................................. ................... .....•--•-----------.-------------------•--•--.................•----------------------•-••-•-.......------------....------.............................................................................. 40111 Of _7 FINAL INSPECTION BY:.. .. ._. ...................... Date..- ._f f i SAN JOAQUIN LOCAL HEALTH DISTRICT L� 1601 E.Wasslton Aw. 300 We�f Oak Strout '--i 1-4 Sycamore Stree! w� 105;4.—t 9th street Stockton,Catifornia Lodi,California Manteca,California Tracy,California C9 9 REVISED 8-59 3M 3-'63 F.V.DD, r �l