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FOR OFFICE USE: i a -- APPLICATION FOR SANITATION PERMIT Permit No.k.._.,a ._-7•! I (Complete"in Duplicate) ------------------..... ............--------------..--- 1 7This Permit Expires 1 Year From Date Issued Date Issued ____3?47 J Application is hereby made to the"San Joaquin Local Health Qistrict for.a permit to construct and instalwork here', described. This application is made in compliance with County 0i;0"e e No. 549. rr JOB ADDRESS AND LOC TI N: +1-_ - - . -- -- . . ----- `` Owner's Name----- ------------------ -• �------/-'-�_._ . -- ••---- ---- --------- ------------- - ---- �j_ �---------- --- Phone-_ (..(P66_�.r Address-------------------------- - -------- A-••- -- -----------••- ------------------------- -- - ---.....---....---------------------------. -•----------------------------------------- -------- -- ----- �- --- ----`-'� -- ---�if---- --------------------------- Phone------ ---•------------------------ Contractor's Nam - __~_ i Installation will serve: Residence partment House ❑ Commercial' ❑ Trailer Court ❑ Motel ❑ Other ❑ ` Number of living units: _ ; Number.of bedrooms a Number of baths --/- Lot size ___ --5-Z-_".. __l'_Z_J—�__------..__ Water Supplyt Public system ommunity system ❑ Private ❑ Depth to Water Table+ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel 171 ❑ Clay Loam ❑; Clay ❑,_Adobe ,. Hardpan ❑ Previous Application Made: (If yes,,date_______________ _ I No Elej Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: septic tank or cesspool permitted if public sewer is available within 240 feet.) Distance from,neares-well-.�...477!Disfance�from-fouridatio _-- Mate-rial _________________...._ q I �' No. of com Jtrrients___--------------------- -__5 ie--_�----------- ----------_hquicf depth_--`---- - - Capacity-------------- -------- Di I F' Distance from n f -- oa k r�oh ply { ' o? ' . Bares well:-J7-4-0T--- :isce from foundation______. . istance nearest lot line_________________ g , Number of line`s.________ � Len t'n�of,each line_-_ �Q_r �.__.�.Width of trench__--__�"GCs _ ,, - 3, �� , r \`qtr ------------ Type of filter material_____ _________ ____ Depth of f Iter materraL__�._ T fiat length______--- - _-------__-.____.__ Pa e Distance to neare lwelL_ --Distance ram foundatio __ __ __._____ tan��o nearest lot lin -:-"o "�• �j t Number of pits:.____.___. 2. ___ Lining material__ s_ _ Size: Diameter'._ ,=7__.._.__De p Cesspoo : Distance from nearest well----------- r;Qistance Efro, oundation_________________ _ Lining,material-_.------------------------------- ❑ ..Size: Diameter,'_. ----- _ ' Depth =- --------- ------ --- 'biquid CapautY gals. Privy: Distance from ineoest well-----------_J- -:____.'14-1_____________rb stance from nearest building � ` _ g------------------------------------------ Distance to nearest lot line ..--------- - _ '--._" - -------------------------------- Remod ling and/or or repairingc .:_...___.____ (desI ribe,),.�ti,-- ----------------------- { - - - � 3 -------------------- -- � P , i ----- +� -------- - - --------------- I hereby certify that I ave prepared Aiis,application,an that- a work will be-done,in ordance with San Joaquin County ordinances, St la an � les and gulations of the S Joa i a istrict. (� cA . (Signed)---- - -- ---- ----�'----- - -- --- - -------- --- --- ----= f .( 1d ,--Contractor) By--------------------------------- ---------- ------------------ ---------------- _ -(Title)----- -------- -- - -------------------- -- --------- (Plot plan, showing size of lot, location of system in relation to ells, buildings, .er ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- = --------------- -------------- DATE----- APPLICATION REVIEWEDBY----- -------------------------------------------- ---- -------- -------------- --------- -----------------------•-------- DATE BUILDING PERMIT ISSUED-------- ---------------------- -- ------------------------------------------------------------------ DATE------------------ Alterations and/or recommendations:-__.-...._..._-__. ----------------------------------------- ------------------------------ ---------------------------------- ---------- ------ ------ ------- --------------- ------•-------------------- "_.,�--------------------------------------------------- ---------------------------------- -----•----- ------ -------------------------------- ------------------ ----------------- --- �---- - ---------------- - ------------------------------------------ ----- i -------------- - - ------ ........ ---------- ---- . - ------ -, ------------ -------- ---------------- --------- -.------------------------------------ ----------------------------- ------ ter... INSPECTION BY --- --- -_ .-----" Date ----------- FINAL -7 ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore Sheet 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California 9 E.H.9 2M 1-67 Vongupra'Press ii R -