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FOR OFFICE USE: ------- APPLICATION FOR SANITATION PERMIT Permit No. ../.. 11 .... ------------------------------------------ --- --------- (Complete in Duplicate)_ -. --- -- -. ...,.,, -Date-Issued -------------._____________________________'_____--- ___ This Permit Expires 1 Year From Date Issued E 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. T 1 - f' JOB ADDRESS AND LOCATION '{ s - - -P"r' / �+ p t / / / ,�• ,( Owne'r's Name----------A,-4--•---------•---*�--��-�--1�✓- --- : ._ =_�f_Y_�_1C Phone f {f�__ ! L Address - .4 ___________ - Contractor's Name_______ _______________ ------------` _-�C 1--- ------ --------------------- Phone4&6 /,?.0_ .7- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __#_____ Number of bedrooms _`s' Number of baths Lot size ___ _ _ _____________________________ Water Supply: Public:system ❑ Community system ❑ Private Cg, Depth to Water Table 60 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 'Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe,[K Hardpan ❑ �' Previous Application Made: (If yes,date__. _`___._____=_`1'.N0 New Construction: Yes ❑ No FHA/VA: Yes ❑ NOX i TYPE-OF INSTALLATION AND SPECIFICATIONS-* r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------'j_______Distance from foundation--------------------Material______._--___._._____________________.______--__. ❑ 041 No. of compartments-----=---------------- --Size-----------------=------------ Liquid depth--------------------------Capacity----------:------------ Disposal Field: Distance from nearest well_________________Distance from foundation---.-----------------Distance to nearest lot line___._______--__- ❑ Number of lines-----------------------------------Length#of each line-----------------------------.Width of trench---------_-------------------_---------------------------------- S Type of filter material_________________________Depth of filter.,material-----------------------Total length---------------._____,__- �+_ Seege Pit: Distance to nearest well-._.5��_:_______Distance from oundation___z or___..Distance to nearest lot line--------- __Sr ` .. r Number of pits.-C-7-At _ __.Lining material___ __ __ {._ Size: Diameter___ r _ _ Depth___Z �___-.- Distance from nearest well-__ ;? ---_Distance fromn foundation__��_.____:_.Lining material__._-'__P©......�%_--_______- 7`" �C' Size: D ------------------ - --- Liquid Ca acitY ;a � 145gals. Privy:'. „Distance from nearest well------ _-------------------------------------------Distance from nearest building----------------------------------------- Distance ----.______-,________._-Distance to nearest lotline--------------:------------------------------- ----------------------------- ------------------- Remodeling and/or repairing(describe):_.._ + ( J /( w-� ---------�~n "� 4 -------- ------..PA.,L-- --- '-----------------------•---------------------------------------- jz ----------------------------•---------- ...._------------------------------------•----------------------------------- --------------------------------------------------I----------- I-hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. . _ (Signed)------------------yH - ----- ------- �'-�"�5- --------LAI1_4"x--!------ t-------- ----- ,----------=------------ ------- - .(Owner and/or Contractor) By:----- -- - �f uc. eG rile " ff S In (Plot plan., showing size of lot, location of system in relation to wells, buildings;:etc., can be placedVon reverse.si- FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY---- ------- - ti_ -------------------------------- DATE �----t----- REVlEWED BY - --------- DATE. BUILDING PERMITISSUED--------------------------------------------------- - •--- DATE----------- -_- ----------------------- .. _ _- � Alterations and/or -------- -------- ----------- ------------------------- - ----- -------------- --s__�.. — ccs=a- ! _ ------------------------------------------------- ----- ------------------------------------------------------ ------------ - ------------------------------------------------ - ----------------------------------------------------------------------------------------------------------- - -----------------------•------------ ------------------------------------------- ------------------------------------------------------------------------------------------------•-•---•-------------------------------- ------ ---------------•---------- 3 FINAL INSPECTION ----- Date- ----------------- �U SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasollon Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVIBEp 8-59 3M 3•'63 F.P.Cp.