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F R OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. . .. ........ c -9/ya ------W___ r ------ (Complete in Duplicate) d 1_3-----0—---------- This Permit Expires I Year From Date Issued Date Issue ---- �� cation is hereby e San Joaquin Local Health District for a permit f o construct and install the work herein described. Tt�rq n ib d Tis app icatioN is mad nce with County Ordinance No. 549. JOB AD -------- DRESS AND LOCATION__ ----- --------- ----------------------------------•----•--- ------------ Owner's Name--------- r ------ ---------------------------- --------- -------------------------------------------- Phone-1-------------------------------- Address-------------- __ 4---------....-•1 1 - - ---- - --- -------------------------------------------------------------------------------------------------6----------------------------------- Contractor's Name--------- ---------------------*------------------------------------------------------------------ Phone,------------------------------- Installation ,----.-------------------------- Installation will serve: Residence �Aparfment House E] Commercial E] Trailer Cdurt E] Motel ❑ ',Other ❑ Number of living units: __/_ Number of bedrooms —5'- Number of baths _f___ Lot size -7 -------------- ------ Water Supply: Public, system Community system E3 Private [] Depth to Water Table _W 'V Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe @--"nardpan E] Previous Application Made: (If yes,date....................J No le— New Construction: Yes R? No E] FHA/VA: Yes Z3— NOX TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic fank.or cesspool permitted if public sewer is available within 200 feet.) 'Tank: �e from foundation__.-/ ------- Material-je Septic Distance from nearest wVeL__T!rrn------Disfanc - , - Z ------- ------------------------- No. of compartment X1--------------- Liquid de0h------ -------Ca pacify-_,10Q1417--- _ _._____.Distance- to nearest lot Iine.4�.,------ Disposal .Field: Distance from nearest well._..'_...._._._..Distance from foundation____)Number of lines_______t2______------ Length of each line---- -------------Width of trench{_2-.`_____________...__.__._ �Depfh of filter material------ ----Total length-- ------------------------ --- --------- --- Type of filter mafer;ai "Jou Seepage Pit: Distance to nearest well--------—---------Distance from fou ndafion dation-___._._-_.Distance__Distance to nearest lot line- Number of pits.__,_-----------Lining maferial__,,&00----Size: Diameter,!.�-------Depfh_,m�. _7_;,4V Cesspool: Distance from nearest well--------------- 0 n --Distance from f unda�io ..------------------Lining material---i--------------------------------- --------------------------gals. ❑ Size: Diameter--------------------------------------Depth------_--------------------------------------------Liquid Capacity I 1 .00 Privy: Distance from nearest well_______________________________________-.-. --.-Distance from,nearest building------------------------------------------- ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------ ------------ Remodeling and/or repairing (describe):_ ----� ------------------------------------------------- V ..........I----------------- -----------------------I---------------------------------------------------------------------------------------:------7--!----------------------- --------------------------- ------ --------------I-------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- - ------------------------------- ------------------------------------ ------------------ ......I----------------------------------------------------------- --------------------------------------------------------------------------------- ------- I hereby certify that I have prepared this application and that the work will be clone in accordance with San Joaquin County ordinances, State laws, and ules and regulations of the San Joaquin.Local Health District. (Signed)----------- ------ ----------- ------ ------------------------ - --- ---- (Gbmmt;,�� r Contractor) By:----------------------------------------------------------------------- ------- - --- - --- - ------------ ------- --------------- -------------- (Plot plan, showing size of lot, location of system ' elation Z wells, buildings, efci, can be placed on reverse side). FOR DEPARTMENTk?U,SE-ONUY� APPLICATION ACC,5TED BY----------/_/;�------- ---------------------------------------- DATE-------- ------------------- REVIEWEDBY---------------------------- ------------------- DATE---- ----------------------------------------------------- BUILDING PERMIT ISSUED-----------------------—- -------------------------------- --------=-------µA------- DATE----------------------- -------------------------- Alterations anq/or recommendation s.•--- ----------------- • ------------------------------ % .7 - ---------::Z-------- ------ _�---------- ------1*--- ----------- ------------�___ 3/ ----- - --- ---- ------- ...... ---------- ........ . ------ Ece ---------- -- -- ----- ------------------------------------------------------------------------------------------------ 67 1,r. FINAL INSPECTION BY:------.. ...... -- ------------- ----------------- Date---... ---------------------------------------------- S JOAQUIN. LOCAL HEALTH -DISTRICT k. 1601 E.Kaxeltan Ave. 300 West Oak Street 24�Sycarnore Str 205 West 9th Street Stockton,California Lodi,California Manteca,California 1 Tracy,California ES 9 REVISED 8-59 3M 3-'63 F,P.CO.