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FOR OFFICE USE: � ------------------------ ----------- APPLICATION FOR SANITATION PERMIT Permit No, .1-73i6.1 --------------------------------------------------- --- --- f {Complete in Duplicate) - This Permit Expires ] Year From Date Issued Date issued _�/36 h,1� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This ap Iicatfon is macle,in compliance with County Ordinance No. 549. �- %+-✓,+�r..c__:A-vim JOB ADDRESS,AND.LOCATION._______-__----- _•___ ± A_--______-- � z__ --------- ---- ---- --- --------------------------- - -------- --------------------- --- --- Ph Owner's Name------ACA,------- ~ one-_. . ---- - - - -------------------------- -- Address------------------- 9� �5 �� ------------------ Contractor's Name--- = " Phone-.4 ` � Installation will serve: 'Residence P'Apa tment:'House ❑, Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:,I____ Number of bedrooms _ Number of baths.-/--_ Lot.size .--7 -- __7 .Zit ----------------------------- Water Supply: Publicl system �ommunity system El Private ❑ Depth to.Water Table 'Q15.ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa dy Loam E] Clay-Loam F] Clay [❑ Adobe ff"'Hardpan ElPrevious Application Made: (If yes,date---------------- ---) No +Q , New Construction: Yes Eir No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 1E (No septic tank or cesspool permitted if public sewer is available w.thin-.200 feet.) �.,, ' i r. � Septic 4: Distance from nearest well_____ __________Distance from foundation_l�____.__..___.Material__.__'CL? � -----_------, t No. of compartments_____ ________________Size__a,: �_- ?C_ .-_-Liquid depth___'I_____...._ ----Ca pacity-At1Q_ Disposal .field: Distance from nearest well._ ""_.___..._Distance from foundation_1?__�_______.Distance to nearest lot line_ �___ x Number of lines___-a---------------____________Length of each line--7-3- _________._.Width of trench____-;_Z__-5?__`�_. �! G f ____________- Type of filter meterial" �_____ Depth of filter.material__1_$"________._Total length_____/sS�Q---____________________ Seepage Pitj Distance to nearest well______ ________- Distante from foundation___s/9----------Distance to nearest lot Ilne_. ----_.- -. r�umber of its____.. - % P --------fining material 4't-.-.---.Size: Diameter_ . . ------Depth---.. -5$'�-•--------------- Cesspool:' -------------- Cesspool•• tk,•— .,,.Distance,from,nearest,well_________________Distante from foundation___.__.__________..Lining material-------------------------------------- ❑ Size: Diameter---------- -----------------------Depth---------x----------------------------------..-----Liquid Capacity-----------------• ---- -gals. Privy: Distance from nearest well-------------- ''--------------------Distance from nearest building----------------------------------.------- ❑ ----- ------------------------------- - Distance to nearest lot Ilne______________'"`.�___._.. e Remodeling and/or repai ring r(describe):---------.--------------___ _ ^" ---------------------- ----- •-•-•-------------------- -----------------------------••---•--------------------------•-------------------------------•-•-- --•---•---•------------------•----•--•--------------------------- -•---------------------------------------- ------- - ------------------f--�---------------------- Y ordinances, State laws„and rules and regulations of the San a uim Local Health District. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County (Si ned " ^� _ 9 _ )------ � ...... . ----- ---- (Owner and/or Contractor) By:-------------------- --`- Y----------- --------- ---------------------------------------�----------------------------- Title ate- (Plot plan, showing size of.lot, to ation of system in relation to wells,-buildings, etc., can be placed on reverse side). 1 ; FOR DEPARTMENT USE ONLY . �,..._-- .' -'t.'• .. .rte.--. .. ..,,�_ ' APPLICATION ACCEPTED BY -----"i------- ----------- ,t� ` --------------- DATE-----------•- lJ / REVIEWEDBY ------------ , ----------------------------------•----------------------- DATE ---/-- ------- BUILDING'PERMIT'ISSUED --------------------------------------- -------- ------------------------------- • DATE_ Alterations and/or recommendations:.- _ ----------------------------------------------------•---- ----,- ----------- =--------------------------------- --_- •-----------•--•----------- ------- --------------------------------------------------- ---------- ------------------------------------------------- ------------------------------------------------------- I FINAL INSPECTION BY....._ec --- ----- -------------- Date... - - - -- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.hlaxellon Are. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California L Tracy,California ES 9 REVISED B-59 3M 3-'63 F.F,CD.