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FOR OFFICE USE: ----- ----------------------- ------------- -, 7— ----------------------------- ------------ ------------ APPLICATION FOR SANITATION PERMIT ----------------------------.-------- �'> ►%, - "S ' ` (co,�mplete in DupDate Issued lica+el ; --------------------------------------------------------- - ---------- - 9l - � -------L_.l-•- -- __----------------------__.._.- -__ This Permit Expires 1 Year From 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 LOCATION- - � ----� ------- T 1 . Phone.c_�' zj Owners Name------ . �1�yLi '�„" ---------------------- -------- --•-- � I 4�f /' Address_..... 3 /.-•••..e� �� 1 ....... . - ------- �Jit _:_ h� -.�� --------------------------------------------------- Contractor'se Name--- =4Phan - Installation will serve: Residence pa.ment House ❑ Commercial ❑ Trailer Court ❑ Motel--------- Other El t Number of living unifs:,,C_------Number, of bedrooms _� Number of bath _ - Lot size ____________________ Water Supply: Public+system El Community sy'sst ❑ Private-.Depth to Water Table ft. 41 Character of soil to a depth of 3 feet: - Sand E] GEavel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan C] Previous Application Made: (If yes,date ---------- 1 No PNew Construction: Yes' 1I E] FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS (No septic tankfor cesspool permitted if public sewer is available within 200 feet.) / , Septic Ta Di tarice from nearest well- Q�__Dis#a Distance from fouridation_..r-!-__:_____.Mate i.- 'r `�--� ---/-��-�-`--� „Za 1€ ". No: of compartments _ Si"__, --------Liquid depth 1 - ------------Capacity_.0 �. tr —�-- -- Size --- Disposal Field: Distance from neares well -t'D� .Distace from' foundatign_ 1��- ..Distance to nearest lot line_______.. _Len h of each I-ine___ ____ Wldth of trench_ __._.. _ 3ype,of,filter. material------ 4 =Depth of filte� aterlral� Notal length______- -_G?-------------------- g. ____..--___Distance fr om`*foundation___________________Distance to nearest lot line_.-_.____.._-___ Seepage Pit: D'+stanc�-to�.nearest,well_____.-__ ❑ Number of pits----------------------Lining material------------------ -----Size: Diameter-----------------------Depth---.---------------------------- Ate ' Cesspool: Distance from near6st�wel__ _____________Distance from f undation________-_.___--_ Lining material__________._--_____________.___--_., tb ❑ Size: Diameter _.r{ , ;_ .,Depth-µ-- -- Liquid Capacity gals, Privy: Distance from nearest weiL_____________________.__-.- �-__�i-Distance from nearest building-_.____._.______----_____.__-.-_---- ---. - s 4. .- ❑ Distance to nearest lot line---- ------------ ---------------------------------------------------- ---------- .rJ Remodeling and/or repairing (describe):-------------------------- ---------- ----------•----•------- ---------- ------------------------ ----------------------------------- -------------------------------------------- ----------- ----- . } _r--------------•-----_-.--------------•------------------------------------------------- -------------------------------------------------- - 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, and rules and regulations of the San Joaquin Local Health District. _ / d an Owner I. - Ownor Contractor (Signedl -.. ...... --- - - --------- -------``�----------: ( -= - (Tifile)----- ----------- - (Plot plan, showing size.of.lot, location of system in relation:to wells, buildings, etc., can be placed on.reverse side). A FOR DEPARTMENT USE ONLY APPLICATION.ACCEPTED BY-A)--, • ----------- ---------------------------------------- DATE.--------'11_,� - -- ;i�------------------ REVIEWED BY--------------------------- DATE = -------------- BUILDING PERMIT ISSUED--------------------------- --- ----.- DATE----------------------------------------------------------- r. I Alterations and/or recommendations:------- ------------------ ----- ------------- - t + -------------••- -------•---------------------- -- if "�l. FINAL INSPECTION BY:_._ .,---- - --- - ------- - - - -- ('�� Date. f - ---- ------- Yom-' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avsi. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED S-59 3M 3-'63 F.P.CO.