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FOR FFICE USE: /G v �- --------------- APPLICATION FOR SANITATION PERMIT Permit No. �............... .. (Complete in Duplicate) /G This Permit Expires 1 Year From Date Issued Date Issued .___._---Z-1 � 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 comp! n e with-County Ordinance No. 549. ---- ---W'i JOB ADDRESS AND OCA =--------- Phone---------------------_------- Owner's Name..-- -- - ----- T .�ts��- - -------- ------------- - ---------------------------------.--------------------------------------- Address.----•-----Izeav- ..--------••-- Contractor's Name-------------------- .: + -i. ------------------------- - - Phone... Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -f-"__ Number of bedrooms__ Number of baths _ ___ Lot size __________________________ Water Supply: Public system,❑...Cammunity system rivate.❑. .Depth.to W.ater_Table.160 . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No U2-- New Construction: Yes g?"l"o ❑ FHA/VA: Yes Flo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest.well __"` _____Distance rym foundation_ofound ,Aeo?- ----Mat�i l_6_6_0,/-e _ _________________ No. of compactments___'Z----- ---.---_---Size __ _ -_.Liquid depth---- Capacity__ ��.�________ Disposal Field: Distance from nearest well_.__`_'�'__p._.Dis#ante from foundation_ __ /_ __ �I� ......Distance to nearest lot lirle_!?��_____.. ------------ ---------- Length of each line_.. -- Width of trench--X --�-•-.--------- --.-- Number of lines_____ __ Type of filter material- Depth of filter material----�i�_________Total length___ O _ __-.__-________________ -� /� i Seepage Distance to nearest well----- -----------bistance fr m fou ation---!_ ........Distance to nearest lot line_ ____.-.___._ �� Number'of its_____ ____________Linin material___ . __ _.Size: Diameter_ �� �' p sr� g �'��--------- ----Depth j Cesspool: Distance from nearest well-------------_----Distance from foundation.-------------------Lining material__._.________----_.______-____-_____ ❑ Size: Diameter----------------------- - -------------------------- u' _"�liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------_------------------------------Distance from nearest building_______•______.____--__-_.____.______._. ❑ Distance to nearest lot line------------------------------------------------------ ----------- -------------------------------- Remodeling and/or repairing (describe:--------- -- - E ------•--------•--------------•------------------------------- --------------------- --------------------------••-•------------•------•------------------------- ------------•---- ------------------- --•---------- �---------------------------------------------------- ..------------------------ U --- - � = ` - --------------------------------------------------------I------------------------- -------------------------------------------------------------- ------- •-_ .-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawsand rules and regulations of the San Joaquin Local Health Distr=ict: " (Signed)------------------------- -- - '' -----------------------( or Contractor) By:----------------•-•----------------------•--•------ (Tit (Plot plan, showing size of lot, location of s 7 m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY----------------------------------- -------------- ---------------- - � DATE------- ' �I' IO REVIEWEDBY--------------------------------------------- --------------------------------------------------------- ------- DATE------ -------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------- _ DATE----------------- ------------------------------------------- Alterations and/or recommendations:-----14, ry ----------------------- -----• -•-----------C ----------...-------•-----------------•-------------------------------------------------------------------- ---------------------------•--------------•--------•----------------------------------------------------------•--- -------------------•----------------------- -------- --------------------------- -------- -- --------------------------------------------------------------------.-------------------------------- ------------ ------------- -------------------- -----------------------------.------------------------------ -•--------------------------------------------- ------------------------------ --------------------------------------------- f 6 '-- -- � ' -- --� -- --------------------- FINAL INSPECTION BY--------------------- - Date------ -------------- --- 2 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stacktonr California Lodi,California . Manteca,California Tracy,California ES 4 REVISED 9.59 3M 3-'63 F.P.CD.