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jrKU-F1(_t USE: ----------------- /0:3 v .� --- -- -----'---------- --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. - i .(Complete1n Duplicate) ---- --------- ----------- This Permit Expires .1 Year From Date Issued Date Issued 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 AN LOCATI N ti_ _I-.� 1 G ------------ }-� t Owner's Name------- - -- - ---�:__�---•- - - e -_-•-- -------------------------- -- ------ Phone-4-7 r-.. Address_. ---------------------------------------------- - --------------------•------------- -----._... Contractor's Name--------- �O � � Phone.._• --f Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: Number of bedrooms ._3-- Number of baths "I_ Lof size __.- � f I, Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table c?Q_ ft. Character of sail to a depth of 3 feet: 3 Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date.__ ----) No New Construction: Yes ❑ No �`] FHA/VA: Yes ElNo� TYPE OF INSTALLATION AND SPECIFICATIONS: / Y, � (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' p .� .�& Septic Tank: Distance from nearest well'_________________Dis#ante from foundation_______..-______.__.Material------------------------------------------------- - _______..___ __.__ -__ ------------------------ ❑ No. of compartments..............""""-""-_-.:Size______________- -----------__r Liquid depth-_-______ __Capacity # .1 � p Y Disposal Fiei Distance from nearest well-----Sr0__'._Distance from foundatio '�.__�"_.--""Distance to nearest lot line_.- Y—Of Number of lines j_•-----,)-----------•----- :Length of each line'- x' � _-•---------.Width of trench---------F77 � Type of filfer material__c "---____ * T' --- Yp , ' Depth of filter'material.___-__1 *--Total*length---------------------"7 . Seepage Pit: Distance to nearest well F-1 from foundation-----------..._____. Distance to nearest lot line_________________ _ ❑ Number of pits--- -----------------Lining material----------------------.Size: Diameter------- -----Depth----------------- ----------- f Cesspool: Distance from nearest well-----------------Distance,.from,foundafiion--------------------Lining materiel----------- """""_---" - -- ❑ Size. Diameter Depth - -----Liquid Capacity-----------------------------gals. Privy: Distance from nearest wel!-------------------------------------y------------Distance from nearest buildin 9-------------------------------------------- ------------------❑ Distance to nearest loft line._____. > a4 -------- ------------------------ Remodeiing and/or repairing (describe) �_ � - -. .__-_____- _3._ --------------- t -> _r _� �.._ ------ ------------------•-------------------- i ------------------•----------------------------------------------------------------------------------------- -------------------•-- "t ------------ __ ------------------ ------------ cert-- that I have 9--_•-------- ----------• ----- --------- ------ -- -•------------•---- - -------------------------------------------------------- It Y ordinances, State laws and rules arnd re ulat ons of San JoaquinCocal t, p application II be done in accordance with San Joa Joaquin Count ' � Health District. � (Signed)_ F r� Tr �i (Ow er and/or Contractor 00 Byc.. -,.._. --.. I . (Titles ------ (Plot plan,.showing size of lot, location of system in.relation to wells, buildings, etc.; can be placed on reverse side). N FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- _......_.__-" �-�..� ------------------------ DATE 9 f G REVIEWED BY -------------------------- ------°E T BUILDING PERMIT ISSUED------------- =----------- I # ? ---------.--------------------------------------- �.: ----- DATE A aerations and/or recommendations_________________ '- I" --------------------- I ___.___-----"-_.___. - y ________________ _______________________..._ 1. * .------.----------------------------------------------- .. ---------------------------- T �-- ser. �. y.,�. .,mow, r FINAL INSPECTION, BY; -: _ 7_� ------------- •[ Date---- SAN JOAQUIN LOCAL HEALTH DISTRICT 7 { i --------- ------------- ' 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.Cq. '