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FOR OFFICE USE: I ! Or--------------�_----- r - - 6b_ _______________r' �-" APPLICATION FOR SANITATION PERMIT Permit No. 6.................... .._.. rs i---` `` (Complete-in Duplicate) I�� This Permit Expires 1 Year..From Date Issued Date Issued .._ _ Application is hereby made to the San Joaquin Local Health DistricfYfor a permit to construct and;,install the work herein described. This application is made incompliance with County Ordinance No. 549. # JOB ADDRESS AND LQ CiiATION-------. ` Owner's Name--------------- 'IFI- --------- e r ;ag "'-� ------ ------------------- -• Phone ---� ----- Address........................ :�! / ----•----....---•------------- ------=------------------------•------------------------- --------------- •-------•---- ----- ------------------------ E Contractor's Name ... Phone. - ------ ----- - ------------------- ;---•.. Installation will serve: Residence- Ap rtmen7Hou e ❑ Commercial ❑ Trailer Court ❑ Motel Other ;ip ; � � P4 , i, � �_ _ �„ �dires pwnsr - rn icense No- Phone C:harac}er of soil to a depth of 3 feet and ] Gravel-❑ Sandy Loam ❑w6ay,Loam ❑..' Clay ❑ Adobe Hardpan ❑ Previous Application Made. (If yes,clatelAt-- l- No [ New Construction: 'Yes to ❑ FHA/VA: Yes ❑ No. c TYPE OF INSTALLATIONIJAND SPEC IFICATIONS: '� � � L (No septic tank or cesspool permitted if public sewer is available within 280 feet,) `' Septic Tank: Distance from nearestwelL_________________Distance `from foundation ___ Material`'...._____ • No, ofIcom artments_ Size_____. _,___ _ f j If P: Liqu+d d th -- "- Capacity------------- .------- Disposal Field: Distance from nearest well': i�. Distance fromlfoundation ..f - :_Distance to nearest lot line :___.__.- fNumber of lines ._-_; `t It "Length"ofZch line.t_***_ _..Width of trench--.----- ------ r ___.:.. ........... r r ! ,d "Ty`pe of filter._matenal�.__.� Depthlof�filter material .___ . otal length___. -_..�7 __.______ __ Seepage,` - ;S� 1Fa ' , t. d Distance to nearest well._.__. �ldteT-----Distance.from foundation._IQ__._,__Distance-to nearest lot line_.__+r±_-__- 0 Number of pits:__ .._� _...:_z Lining' mate, rte / ._. Size:} ec .___Depth --.._. ?_.�__:` ._ Cesspool: Disten� from nearest iwell ..� :Distance from foundation 4'"___ Lining material _. E] Size Diameter. -------- _ _-- ---.Depth _Liquid Capacity_ _________ ____ •-gals. Privy: ' Distan 6�5e•from nearestwell.... Distance from wrest building______ __ _____ _ •.` ❑ Distance to nearest lot lined------------------------------ r __- Remodeling and/or repairi 'Edescribe]:- .. . ..... [tea_p, e - -- --- - - ` U -' ® T - -- ---- - ------ I�. ,,w 11 _�.• , ------------------------ - --------------------------------- ------------"---•---------------- -------- -------•----------------------- - -- . .... ' I hereby certify that 1, aye prepared`this application and that the work will be-done in accordance with San Joaquin County ordinances, S to laws, and`,rules and r g tions of the San Joaquin,Local Health District,1 }' pp ------------------------ s t.(signed) ------ ---- -- ---- ----- - (Owner and/or o ntract or) By. --•--------------------`.1--------'---------- ------- --------"- --------------::--------- ------------- "------------(Title)------ - ._. ... - (Plot plan, showing size of lot, location of system in relation to Wells, buildings, etc., can be placed on reverse side). .,I, Y FOR DEPARTMENT USf ONLY APPLICATION ACCEPTE01"BY <. ---------% +_-z------•"---- DATE----------- � = v iREVIEWED BY-----'-------------- ---------- - ,. -------------- ------------- --------------------------------------------- DATE------------- ----------------------•------ - B.UILDING PERMIT ISSUED'" ------- �,A-T -- -------------------------------------------------- Alterations and/or recommend/ations:---_6_1..._.(��--__......-�.��__._ [�_ �f ___ f�-.�, �MA-xL 3 - G - ��= mit r ' �! a -----• - . ki j7- , ---------- --------- - . •--------------- --" ------ -��--- r �: � -- - '----.------------- -----.----- -------------------------------- - - ---- -- - --- ------- t FINAL INSPECTIONBY�'.: ""= --------------- ---- - -- ---------- Date = - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave, 300 west Oak Street -124 Sycamore Street 205 west 9th Street Stockton,California Lacli,California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press A.