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USE; 3 ------------------------- ------ �-r-7-�_-_____ APPLICATION FOR SANITATION PERMIT Permit No. ' ---------------------- ti -' ;:41 6 -. �,.,a, (Complete in Duplicate) --------- ---------------------- This Permit Expires 1 Year From Date Issued Date Issued ....... i, 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 AND LOCATION.__I_� -2.3----- -__ Owner's Name _- --• Phone--------- y - -- one ---- Address----------- ' Contractors Name s_.1 r—�7. Phone_------- Installation will serve: Residence 1] Apartment House ❑ Commercial ❑ Trailer Court Ej Motel ❑. Other ❑ i �} �� 'p-•�} Number of living units: -_____Number of bedrooms _- Number.of baths ___/___ Lot size '_� — I n1 ----------------------------- Supply: Public system ❑ :,Community system ❑ Private ❑ Depth to Water Table` --ft. Character of soil to a depth of 3 feet: I Sand ❑ .Gravel ❑ Sandy Loam 0 Clay Loam ❑ -Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date----- --- - --__-I No New Construction: Yes. No t]___FHA/VA: Yes ❑ No 2j— TYPE-.OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic n Distance from nearest well_________________Distance from foundation--------------------Material -_____._________________-.____._--____-__._---_. lo. of compartments-- -------- ------------Size--------------------------------.Liquid tdepth---- ----- -----------Capacity--•----------- r Disposal Field: Distance from neares} well r T s '_Distance from foundation� k______________Distance to nearest lot line __--__-- N ❑ Number of lines-_-:_ ___ Width of trench_______ ___________ -! Q� - ------------------------Length ach fine- Q '-- Yp s Type of filter material___-l_ C _Dept i r material__2- -- � i � ---- •--Total length-------P�'�-=------ ---------------'- W ------- Seepage fiance to nearest;well _:_______-____-__:D' tance fro foundation__!-,�? f____-___.Distance to nearest lot'lin -_-��--.- See�a e Pi Distance of pits___7_ -- %r N f�,u ---------Lining m teriaCi7A-__,k-------.Size: Diameter_----1-----------Depth(��, ------------Cesspool: Distance from nearest well________________ istance om foundation-.-_____________.Linin material____ I ❑ Size: Diameter__._--� }. g ---------------------- ---------------------- ^ " D th ----------- ---- - - Liquid Capacity------------------- ' z --------gals. Privy: Distance from nearest well-________________- Distance from nearest buildingIp ❑ Distance to nearest lot line---------- ----------_---+------------ Remodeling and/or repairing (describe] __________________ ______---------------- Op I l --------11---------------------------------------------------------- ----------------------------------------------------- f - 4 r----------------------------- ------ ------------------------- -•--------------------------------------------------------------------------- '. ; ----------------------------------------------------------- I hereby certify that] have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and mules and=regulati s f th San�Joaquin Local Health District. -y^ k ' ------------- -_____(Owner and/or Contractor] (Signed)--------------------------------------------- ------ -- - -- f - --- ---------------- --=----------- -----(Title)---------- " ._ - ---- --------- (Plot plan, showing size_of;lot, locationrof system in relation to wells,,buildings, etc., can be placed on.reverse.side). 6 a _ FOR DE ARTMENT USE ONLY APPLICATION ACCEPTED BY_ J.f —------------------------------------------------ DATE `1� 1 REVIEWED BY f-- - ---------- -------------------------------- -------------- --- -----------. DATE_._ ---------------- - - - Alterations and or recommendation--:-------- ---------------------------------- -----• DATE--------------------------------------- --E 8UlLDWG PERMIT ISSUED___ __ . --------------------------- =--------------------------- --------------------------------------------------.----------------------------------- _________ ----------------------------------------_--------- -----------------------------__-------------------------------------------------------------------- FINAL INSPECTION BY:_._-_C.- -__ __a.___rNJOAQUIN } ----- Date - -- - - -------------------------------- LOCAL HEALTH DISTRICT 1601 E.Nasetton Ava. 30treet 124 Sycamore Street 205 West 9th Street _ Stockton,California 4 Lodi,California Manteca,California Tracy,California { ES 9 REVISED 8-59 3M 3-'63 F.P-CC. f