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FOR OFFICE SE: APPLICATION FOR SANITATION PERMIT Permit No. .. ...:................ ---------------------------------------- ---------- -- (Complete in Duplicate) Date Issued .. y3 ftO is: Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct a d ii stall the work herein described. This application is made in compliance with County Ordinances No. 549. eo JOB ADDRESS AND LOCATION_��0.-.-`--4 -- _-- /! •.'C7&_f, ll__•_ I Owner's Name -------•------------------ ------ Phone-------------------........... Address----_` -�_ -.- .tiP ..... --------------------------------------------------------------*------------------*------------*----------------------*----------- Contractor's Name----- `� ----------•-------•---•--•------... Phone f Installation will serve: Residence 'Apartment House ❑ Commercial 9 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.r.. Number of bedrooms S_ Number of baths S_ Lot size Z.P.Ift. .-�&'---_-_......................... Water Supply: Public system C1 Community system ❑ Private �epth To Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: {If yes,dote-------- ) No [ New Construction: Yes &"Mo ❑ FHA/VA: Yes JR,0 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: \ (No septic tank or cesspool permitted if public sewer is available within 200 feet.)r ,,,��.�••��i yyqq •Septic T k: Distance from nearest we -_brs,----_Dista a fromfoundati n_-/0---------.Material--- - - ---- ----- ----------- No. of compartments_l._._-------__Sizd&&X ir' 07_-1_iquid depth__'O(�---------------Capacity-,�.Z4eYO-.._- r. �. J1110 isposal eld: Distance from neare well-44P Distance from founds ' Ze Distance to nearest lot line_f"' .. Number of lines---.._+----_ _- Length of each line. -_!/:-1tr---/3 �Vidth of trench=-. �- Type of filter material/-t- - Depth of filter material._ /�7.�r Total length--- p---- ------------------ ee 1`♦ ---- i • . > pag Prt: Distance to nearest well ----Distance from/foundation-___�,�_--....Dis�Distance to nearest lot li�----------------- � r Number of pits-.---�------------Lining material- �__.Size: Diameter_. .,3 -----------Depth-4 ------------------ f Cesspool: -----------------(Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material.-------------------.---------------- S*ize: -_----_---_---- Size: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity----------------------------gals. Privy:. " Distance from nearest well----------------------------------------- -------Distance from nearest building------.-----_----_--_-_-_---__.---.------. ❑ Y'.y Distance to nearest lot line--------------------------------------------------------------------------------------......... ............................. -------------- deling and/or repair' g (describe :- - -__..__--_ __-----_---- M •------•-.•--•-----..--- ----------------------•-------••-------••------------------------------......--.-•-------------------------------------------•-------•------••---------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules and regu ations of the San Joaquin Local Health District. %[Signed) ------ --- --- ---------------•------------------------------------- fQwjw& ladAor Contractor) • (Title)- 2 / "' (Plot plan, showing size of lot, location of s + m in relation fo wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY L , �n , APPLICATION ACCEPTED i3Y�-=--- ----------------- - ----------------- -- ----------------•----------------------- DATE_--- -- - •• ------� /---Tn- ----------'--------- REVIEWEDBY-------------------------------- --------------------------------------------------------------------------------------------- DATE-----------------------.--..-------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- DATE. rr Alterations and/or recommendations:_...- �' -- -�' .- � C�`2 �'�(' � J -: - .-.---:' ---------------------•-------------------------------•-••--------•--- -------------------------------------------------------•----------------•-----------------------..__..._....------------------------------ ------- -_--------------------------- -----------........*.-------------------------------------------------------------------------------------------------- ----------------------------------------- F1NAL INSPECTION BY:. �---- ... Date_ ._..-...... — SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak,Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California ja i Manteca,California Tracy,California ES 9 REVISED B-59 291 5-$2 ATLA5