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OR OFFICE USE: 1 - -s _ APPLICATION FOR SANITATION PERMIT Permit No. ___Lo�•�rz_. � ------ j =>< �M -- (Complete in Duplicate) /Date Issued ____________s�'1_--_-- -------------------------------------------------.- .,-.--- This Permit Expires 11 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. 1 , JOB ADDRESS AND LOC TION-- -- -- _-= � -- 44 -- -.-- �� "---- Owner's Name_____ _'__ � —_�-- ---- ----- Phoneme ---------- Address-----•------- -•------ -------- Contractor's Name ___ --------_.___-___ -- Phone______________ -------------------------------------------------------------------------------------------------- -- Installation will serve: Residence :P--A—partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / Number of living units: ______ Number of bedrooms—�� ___ Number of baths _ ____ .Lot size -------- Water Supply: Public system ❑ Community system ❑ Private V2--I5_epth to Water Tablet' ft. Character of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ , Previous Application Made I {lf yes,date---------------------1 No New Construction: Yes ❑ No JF,,�FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool Permitted if public sewer is available within 200 feet.) Septic Tank Distance from nearest well__-��__Distance i from foundation ___.Material --- ----- ¢.- ------ ,� ❑ y�'� /� No, of com artments.____..__ - ______Size__ X r� l Liquid de th_______- Ca acit -__-- - -,v p ---. q P. - --------- p Y- ll: Disposal �field:,�+ Distance from nearest well- Distance from foundati�r.__f.(z�_-_..-- Distance to nearest lot line____---.-. U� 'Number:of lines-.--_ //______�?-- -______Length of eac fine_ l-7 ��Wi � LJ/x' f 9 dth of trench-.-. .00 Type a ;filter material_1&€__Z1_-Depth of filter material---_r =___. Total length--------- -. Seepage Pit: Distance p to nearest�welL__I--['"[ ---_Distance from foundation____-v�. _-- Distance to nearest lot line]�.:_--_-___ Number of its________ _.. . Lining material____�_ r__ ___Size., Diameter Depth____...z_,T__; Cesspool: Distance from nearest well----------------- ___--_ Distance from foundatian________________ Lining material-_._-_____-- _ f r _--___-- '1 Size: Diameter_____-}------ - -------------=_ Depth---------------------- ------------_.- -------- --- Liquid Capacity .gals. ' IM , t `Privy: „ ._ 'Distance from nearest well---------------_._,_-_:_______-------___----------Distance from nearest building_:--- -------------._____._ _______- ElDistance to'nearesfjot-Gne-- ---------- ------- ----- -- --------------------------- ---- ----------------------------------------------------------- 'R�emodeling and/or repairing (descri-be):----• ------- ------------------------------------------------------5----- --------- •------------------------------------------------' Gy-s.1 t - - E ------• --------------------------------I-------- ••--- --------------'-------------- -------•--- --------------------------------•--------------.--------------------------------------------------- ------ I hh eby c ify„tha+I lhavW 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, J” n 1 JE [ '� i __ (Owner and/or Contractor) (Signed). - 64A C----------------- - --- ` [ plan,p Ian, showin y size of )lo _ _,.__t, location of s y'stem in relafion--------------------------- -------------------(Title)------+ EL` ---,-----.---------_--,-------- g II l r ,to=wells,,build ings,,etc,can befplaced on reverse side). FOR.DEPARTMENT USE ONLY APPLICATION ACCEPTED LBY--- "- - ----------------- ----------------- DATE__ _l _..4z--------------------- REVIEWI D BY ��' ---- ------------------ -- -------- ------------------------------------------------•--. DATE---------------------•---------------------------•-------- BUILDING PERMIT ISSUED---------------- •- DATE DATGE---6-----^--r---�-�---- c /� --------------------- -- r- Alterations and/oromendationsu---c.- -----'------ - ------- -•-----= -- --------------------- --------------------- ----- -- u---E--'-�---'-- 1 ----------- �- m -- --------------- ---- ( , ------ -- -C .. ------------------------------------ -- - ------ ---- ------- - ----- ji[/�L/f ° i F AL INSPECTION BY: y y ate 2- /J C,4,- �" �^t cr ,ALL Gam/ ;:) r- , SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave 300 West Oak St etj • : flL24 Sycamore Street 205 West 91h Street ' Stockton,Galiforni , C . California Manteca,California Tracy,California I Es 4 REVISED 6-59 3M 3-16 h