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FOR OFFICE USE: 46 a G` --------- ` - 3° APPLICATION FOR SANITATION PERMIT Permit No. . -6.. --�f (1 (Complete in Duplicate) ' ; !6.0-16Y ._ _..__ _.__ This Permit Expires 1 Year-FroM-Date`,;Issued Date Issued --- --_ ----------------------- 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 L ATI7 ,`_ "' --------------------------------------------------- r , t _ Jt!rtct Uu•ra e t Owner's Name Phone " LLL � - - --- Address---: -------- -- --- ------------------------ - -- ------ =---- ----------------; Contractor's Name-----=----- _ ---------------------------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence U �Aparfinent House ❑ Commercial ❑ Trailer .Court ❑ Motel ❑ Other ElNumber of living units: __ __ Number of bedrooms 2. Number of baths , __ Lot size _(AW�_ .0------------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table + ftt�" Character of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ Sandy Loam 0_Clay Loam ❑ Clay ❑ Adobe H3--nardpan ❑ Previous Application Made: (If yes,date___-------_--------) No Z?' New Construction: Yes 4j"No ❑ FMA/VA: Yes ®---No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: > ) (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ____�'_____Distance from foundati( 4ate6aI Ae-_4. � _______- UK No. of compartments------��'---------_---Size_.tfd� _ Q ..Liquid t depth----or- /f..___.___Capacity---eA- ... . Disposal Field: Distance from nearest well...° r------__Distance from foundaJttjo _-/7-------Distance to nearest log line.-A------_ Number of lines___._____ _______________ Length of each Iined� C__ _._.Width of trench_._��______`________________._ Total len -_ Type of filter matehal-_� __.__Depth of fi ma)ai � ��_____ gth__�o.' �__ _________________. Seepag Pit: _ .Distance to nearest welL_____�T______Dist ce fr m fo tonearest lot line__f .______._Number of pits___�A____________Lining mat ial_/; . ._:.. Dia°me er -_...___Depth_X.%, 'r" ___________Cesspool: Distance from nearest well________________Dist ce from fou _._._Y.__i.__.±tLining material___.___._..______.____________.___ ;Size: Diameter---------------- = ---=-----:Depth-----=-----------=------ - - -i----;-�-ZfiLiquid Capacity----------------- --------gals. I Privy: bistance..from nearest well_____________________________ ------------------Distance.from nearest building-----------------------------_- 1 ---- -I_--------------------------------------- ❑ Distance to nearest lot line__________ __ ____ i Iv Remodeling and/or repairing (describe):-------------- fl��rLl � -- •----•-----------------•--.._--..---..----------------------------------------------------------------------: --------------•---' -------------------------------------------------------------------------- ---------- ff i )-------------f ------------------------------,---------•------- --- -------------------------------------------------------- -------------------- -------------------•-------------------------------------------------------i - --------------------- -. -.. ---- - ------ - I hereby certify that I have prepared this application and }bat the work wild be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District:- Zt(Signed) ----- (Plot k. t (Qwaef-atler Contractor) B -- ---•---------------------•---------------------------- --- - ------`''` --------- Title -' (Plot plan, showing size-of lot,-Iocation_of_system-inrr ton,.to wells, buildings, etc., can,be placed on reverse side). FOR DEPARTMENT USE ONLY ( i APPLICATION ACCEPTED BY = ' y __ DATE------e� 10 p�G�--------- ---------------- , REVIEWEDBY------------------------------------------------------ ------------------------ ----•--------------------------------------- DATE------------•-------•--•----------------••---------------- } BUILDINGPERMIT ISSUED----------------------------------------------- ---------------------------- ------ .DATE--------------------------- ' - - - _ -. - ---- Alterations and/or recommendations:_...___ _--------------------------------------------------------------- /` � . ---------------- - ------------------------------ -- ---------- -- - -- -------- -------- - ---- -------------------------------- •-------•--------- ------- ------------------------------------ r I ------------------------ -------- -------------------------------------------------------------------------------------------------------------------------- 3 FINAL INSPECTION BY:--- Date-------- - - SAN JOAQUIN LOC[AL-HEALTH DISTRICT , Vf 160v E.Hazellon Avo. 300 West Oak Street 124 Sycamore Street 205 West 91h Street y Stockton,California Lodi,California Manteca,.California Tracy,California ES 9 REVISED 8.59 3M 3-'63 F.P.CO. 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