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FOR OFFICE USE: -------- ----------=----------------------------------- Permit No. 17—S79 --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT ---"-.----_. �(Complete in Duplicate) ------ ---------- -----_.:--- ----.:-- -- - - Date Issued .---- ---�------ ----- --__,__-- --_ This Permit Expires 1 Year Froin Date Issued --------------------------- 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. 6?v Al cu�� d) JOB ADDRESS AND CATIO __!!� ��Z �` ----- "" ----•------- Owner's Nam ---- - -- -------- - -------------- Phone---------_-------------------•--- -- Address---- ------ --------- 4.- 01 r ---------- Phone--------.....-----•----•---------•- Contractor's Name___--" Installation will serve: 'Residence ❑ Apartment House❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Num��Dbe baths _.__ -- Lot size ____________________ ______ _ Water Supply: Public system ❑ Community system ❑ Privatepth t Water Table -------- ft. € Adobe Hardpan Character of soil to a depth of 3 feet: . Sand ❑ Gravel 171 Sandy Loam Clay Loam ❑ Clay ❑ ❑ ❑ " ' t* rr- Previous Application Made:( If yes,dote_-_________________) No ❑ New Construction: Yes [INo E] FHA/VA: Yes ❑ No El "�� TYPE OF INSTALLATION AND SPECIFICATIONS:t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: �. Di�tance-from nearest well-----------------Distance from ❑ foundation--._"___--_____.---.Material-.__---"_-----..___--_._ .--_._______._.______--. a acitY : o. of compartments-------------------- -- f Dispo Field: Distance from nearest well_...r�' 0- -.Distance from foundation-----/_O_____._Distance to nearest lotline__5.. ._....! Niarriber.of»lines----------_- "-- ----------------Length of each line-----71---------------.Width of trench.._-, �,--------------------- 07 Typeof filter,material_ r" "-.--Depth of filter material___._ --- ---------------------------- f length------ - ` yp -=----- ------------------ Seepage atrial- Pit- ' .�.�Distance'"to`isearest well-----------------__---D'+stance from foundation_.____..._____.•___.Distance to nearest lot line__..___.___._____ El Number of pits----------------------Lining material-------------- -----.Size: Diameter Depth � "k, h+ r, 4y4 y'�'- �,_ Cess ool: ` ,, '—,Distance from nearest well---------------_"Distar$ce from foundation_...___.______.___.Lining materia______._.___._.____._________..____ ❑ De th ----------------------------------- - -------------Liquid Capacity----------------------------gals. Size: Diameter--'-,---------�------„------ �. , Priv Distance from nearest`well:_�`___"""_-----------------------------------Distance.from nearest building_""""_--_.______________.-____'----------- Qistance to nearest lot line ----------- --------- ------------------ -..------------------------------------------- ------------------------------------------------ El Remodeling and/or repairing (describe)-- A - -----------------•---------------------------------------------------------------•------•------•- ---------- -- ----- ------ -- ---- ------------------------- € R --------------------------------------•--------- T L. Ilt ------------------------ -------------_-----------------_----- _------------------------------------------------------------------------------------------------------- 1 hereby certify that'l have prepared this application and-+hat the work will be done in accordance with San Joaquin County ordinances, State laws, drules and regulations of the San Joaquin Local Health District. r Contractor (Signed)--- - �— '' _ By:------------------ --Ll(a --D. --_---- --- (Title)- ------------------- ------. .... ----------- B (Plot plan, showing size.of,lot, Iotaon of syste?in elation to ells, buildings, etc., can be plaied an reverse side). FOR DEPARTMENT USE; ONLY I 0'_ �_(Y--------------------------- APPLICATION ACCEPTED BY"...� -- -- -------- ---------------------------------------- DATE------ ----a�--------- REVIEWED 1Y--------------------------- ----------------- ----- DATE_ - � ------------- ----- -----------------' r -� r il3UILDlNG PERMIT ESSUEQ-------------------'--------- - ------------------------------------------ ------------- --------- QATE---------------------------- ----:--------------:---::�- 1 Alterations and/or recommendations-----------------------------------"---------------------•-------------"---------------------------------------------------------- •-------� � ------ ------------- -------------- --------------------------------------------------------------•--------•-------.-.-_-- ./. ---------- ----------- =--------------------------- ------------------------------------------------------------------------------------------------------- a -------------------------------------- ---------------------------------------------- __... A FINAL INSPECTION BY:._ - �?rr� '�'. ------------------ Date_ t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California I E5 9 nEV16Eo 8.59 3M 3-'63 F.P.CC.