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FOR OFFICE USE: I� � Permit No. . 10_ APPLICATION FOR SANITATION PERMIT -------------------------------------- ------------------ ff --------__A------- ----------------------------- ------- (Complete in Duplicate).- ------------ _ Date Issued ----- -- fit ---------------- --------------- --------- This Permit Expires 1 Year From Date Issued ` i Application is hereby made to the'San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. ' r --• T' —•-/v-- ---------•------- j JOB ADDRESS AND L CAT - _ _______--------- ---- -- - Owner's Name..-- --- - - - - ---------------- - y - ---------- Phone--------- ----------•------- Address--_. .r 5----- - ------ - --- - -- -----4 ------- -- ----------------------•-------------•-•------------------•---------------•------------ 019 Centractor's Name-----•-•-•---------- ------•--=--------------- Phone----------------------------------- Installation will serve: Residence Apartment House E] Commercial [:] Trailer Court El Motel ❑ Other El Number of living units:, umber of be _P! Number of baths le? Lot size __1--- -------------------------------------• Water Supply: Public,system ❑ Community system ❑ Private Depth to Water Table ;7 ft. Character of soil fo a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe V' Hardpan ❑ Previous Application Made: (If yes;date--------- -------) No ❑ New Construction: YesNo E] FHA/VA: Yes [3No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200,feet.) r Septic Tank: Distance from.nearest well_�d_- ___Distance from foundation_-_ ---Matenal_-__Px_e__________ _ ___ _______________ 3 _Liquid depth__--l_�___-----Capacity... QO__ No. of com al=iments____ _ _ Size_ _-_-S __ _ __.___ -- Disposal Field: Distance from nearest well__15_0 --_Distance from foundation._,7,Q---------Distance to nearest lot --_ line -5___---_-_-.-.-r.- _ =Number of lines-----/--------------------------Length of each line__ Q-_ : _-----.Width of french__.__. __._____-__------ Type of filter material_ _ o� . Depth of .flter material__ �_�y------Total length------------------------- r - fiy Distance m fo dation___- ? ,� Distance to nearest lot line_________________ �;;,,..�,Y„• 5eepa e Pit: Distance to nearest well __-_-- -••----- r Size: Diameter-_-. Number of pits------/-------------Lining,material__--_ -- - .��--��-Depth......a'�-'�E---- ' e`arest well______________-_Distance from foundation------------------- Lining material-__-_._ Cesspool: Distance from n ----------------------------- - _Liquid Capacity . ❑ Size: Diameter---�--------------'------- _}Depth--------------------- •-----•-•-------- ------- P Y--------------------------- als Privy: Distance from nearest well --------------------------------------------Distance from nearest building--.-_._____-___--__________-__-_.-___--- __ ❑ Distance to nearest lot line-'' ------------------- -------------------------•---------------------------------------- ---------- -- --- Remodeiing and/or repairing (describe)=---------------- ---- -----------••--------• ------------------•------------------ --------------- ---------------------------------------------------------------------------- -------- -------------------•-------•-----..._.:-•------•---------------------------- •--------------------•----------------------------------------------------------------- -------------------- I hereby ify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, fate laws, and r es a egulations of the San Joaquin Local Health District. (Signed)._- --------- ------- -----'-------- ---------------------------- er and/or Contract ------- -------------- d/o B --------------•--- Title_ wn Contractor) y•-- ----- -------------- ---- - [ ) I (Plot plan, showing stxe of lot, location of system in relay to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 13 APPLICATION ACCFPTED BY--- ----- cam-L= ------------ •----------••----------- DATE 'S:��' ��,• 7 - ------- REVIEWEDBY - ----------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------:----------------------------------- --•----------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations;---•------------------------------------ ------ ----------------- -----------a------- ��•---,------ ;�--�----- �------------ - ---•.--- - �c�.h. L I �["'^ v"*.'•" `'¢_.`-t�-' -G....l.--,tet °GC---C----�----------------- --------------------------------------- --- ---r i------------c�.� _ ---- --�r� ---�•--1 -.------ ---------- --- E- ------------+Y-..---------�------ - -- +r�'CrY �-----/=j r...-s � -�- � �..Gl./ t�re�---r7e_d � -�-��'-t' r'�' ----------- / `-- 9 9 `7 Gt� FC� (1 � d ( C�-� FINAL INSPECTION BY:.. x t-�� Date_ ------�-- � . -------------------- e I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. ' 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California tt Lodi,California Manteca,California Tracy,California I ES 9 REVISED 8-59 3M 3•'63 F.P.CII.