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FOR OFFICE USE: -------- APPLICATION FOR SANITATION PERMIT Permit No. .__/__ _. -.--------- _o C�. (Complete in Duplicate) ---------- " - - '--------- -- This Permit Ex ices l Year From Date Issued Date Issued ___�1 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__-.C�-- -S -__"i C��1T p ________________________________________________________________________________________ Owner's Name //ems -x_0-----`- -..--------•- --"--------- Phone-- - ' Address------------/-d.-Y-`?.e........... . Q -Y..lr .._.:__...- G -----•----------------------------------------------•--•----•------------•-I——--•-------.--•------------- Cantractor's Name /f- -- -------------�-� -------- -•-------------- Phone.Ar! r I� i d' ys Installation will serve: FResidence [I—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel .❑ Other ❑ ij Number of living units: ._�__- Number of be rooms __.- Number of baths _ -._ Lot size ------- 14re rc Water Supply: Public-system '❑ Community system ❑ Private []—Depth to Water-Tables_ ft.' Character of soil to a depth of 3 feet: Sand ❑ {Gravel ❑ S ndy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Previous Application Made: {if yes,date----------_---- ----J No New Construction: YesN,o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4p r /a f;-c�a�T Cloarc r�'7 e 1 Septic Tank: Distance from nearest well_________________Distance from foundation_______--._________-Material_.___________________--_______._-_....___ - _. No. of compartments:_ --- ...��---'-----Size__——— _ 0-----Liquid depth---1.4/-- -----------Capacity__/_�oV Disposal Field: Distance from nearest well____'ra_/ --Distance from foundation__!_"...........Distance to nearest lot line---J-- Number ine__J-_Number of fines---------------z---_�--------Length of each line-.- -1S---_---_-------.Width of trench------2-e___•-----------_-- N Type of,filter.material---___ _ _______-_Depth of falter matenal___� ___-_---__._Total length_______XS0_�--________-,-____-_- tlI See rt: Distance to nearest;we##____�_r_`'-:--____:Distance from foundation___1-!'----------Distance to nearest lot line_! J________ ❑ Number of pits:........ ----------Lining material___. ------ Diameter----3e__"_..____Depth------- X-------------- l Cesspool: Distance from nearest well __ ---------Distance from foundation_ ------------------ .Lining material_____ _________ --------------- ❑ Size: Diameter-------------------------1---------Depth--------------------------------------- - - --:----L+quid CapacitY----------------------- ----gals. �. Privy:' Distance from nearest well-------_ _________-----------_____.____-_______-Distance from nearest buildin - - - ❑ Distance to nearest lot line Jlrygy,' '• ---------------------------------------------------- ----- Remodeling and/or repairing (describe)----------------- -------------------------------- -----------------------------•------------- ----------------••-------------------•--------------------•------------------=------- ------=-------•---------=---------------------------------------------------------------------------•-- ---------------- ------------------------------------------------------------------------------------ - -•------------------------------------------------------•---- --------------------------- 4 : ------•-------------------------------------------------------=-------• ---------------------------- - ---------------------- J I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State land rules and regulations of the San Joaquin Local Health District. ' (Signed) - � =--- (Owner and/or r-Contract ----------------------------------------------------------- -- --•----- ----•-----'---B .------ ------ C - --- ---------- -------------------------------'------------)Title)- ---------------' - -------------- -------------- (Plot t plan, showing size of.lot,.location of system ini relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------- --- -------------------------- --- �_ _ " DATE ---- -�--- � --L REVIEWEDBY----------------------------------------- -------------------- ----------------- ----------------- ------ DA -------------- -------------------- ------------------------------------- BUILDING - -------------------------------- --------'--------'--- - - DPERMITISSUED T -_' --------- ---:----- '-------- DATE ------- Alterations and/or - -------------- c _____________________________________ e ---------- r r/ �`� cJ° ` :. j ------------- -f a:y 3 - - 4 � __ _ __::_::_,- `_ __:__:::` k ------------------------------ -- �) ----- ------------------ -- -------------------------- -----3== = J.-- df- --- `'` -- --------------------- FINAL INSPECTION BY:. ' 7;� ( ��;,----------------------- Date I/- . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaielton Ave. 300 West oak'Street T• ` 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California ES 9 REVISED B-59 3M 3-'63 F.P.C(].