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FOR OFFICE USE: ------------ -- ------------------ -- -------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- (Complete in Duplicate) 7 -- --------------- ----------- ----- ---- -------------- This Permit Expires 1 Year From Date Issued Date Issued -------_-_G --�-• Application is hereby made to the San Joaquin Local Health District for a perm t, ,const,Fst nd install the orjl�ein.descr This application is made in compliance with County Ordinance No. 549. -n r / ¢ JOB ADDRESS A C TION- F ------- _ Owner's Name-------- � -- - -------------------- ------- - --- -- ---------- ----------------------- -- ------------- Phone _ _3,_t#'f------ Address-----•• ^r--�`-�--- - ---- _ .. �.} i ka Contractor's Name, ;�..�_ � •-- -_ = tl1T Phone— p Installation will serve: Residence partment House m Commercial ❑ railer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedroomsumber.of Ia the _ ot size .��` -------------- Water Supply:�Public°system�❑ .:Community system ElPriva Depth to Water Table -_-_-__ ft. Character of soil to a depth of 3 feet: Sand F] Gravel Sandy Loam ❑ Clay Loam. lay ❑ Adobe Hardpan ❑ � Previous Application Made: (If yes,date--------- -----.._._1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 9 (No septic tank or cesspool permitted-if pu e�4er is available-within 200 feet.) f Septic ank: Distance from nearest ell _ .o__.__Distanc fropa�.fon Iation__ �.___--.Material__ p e `2C =. 0-`r-Li uid de th__ 1Ca acit No. of com artmer --- Siz q p. 7 -. P y--- � Disposal Field: Distance from near st we ___f9.�_-_Distance fro�foynd tLen��____rDistance to nearest-lot lint_____ 4 Number of linea__ _ Length of e h me-�+ '�--. .�---Width of trench._/_ r._ +� Type of filter material_ epth of filter material_,._ e-- Total length______________:... . i� _._ Seepage Pit: Distance to nearest well-___-_.__.__._____ _Distance from foundation------------------..Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material----------.--------_--Size: Diameter------------. : :___Depth_ _--------------------------- Cesspool: Distance from .nearest well-----------------Distance from foundation---------------------Lining material---__._____.______-________________ ❑ Size: Diameter--------------------- ----- -----------Depth.-----------------`-------- ---------------------Liquid Capacity----------------------------gals. Disttsnce:f.rom rnearest well_____" _: _' `°`` - '"`D.istance•rfromTnearest--butldiin P 9 ". " 0 ❑ Distance to nearest:lot line---------"_-- 0 Remodekng or repairing (describe):---------------------------v--------------------'---------•-•------------•----• -------- -------------------------------- --------------------- ------ --------------------------------•---- --------------------=--•------------•----•--•----• -•------------......-•----------------------------------•-----------*-�- --�-----------------•--•---•---------------•'---------- -- 1 ' a ------------------- ---------------- �' I hereby c rtif hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a e s, - d rules and regulations of a San Joa in Local H alth District. [Sign - - -------- ----------------------------- on aT '- ---- -- �.� �r (Plot plan, showing size of lot, location of system in relat' to wells, buildings, tc., can be placed on reverse side).,. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- -------------------------=-•------------------------ DATE------------------------------------------------------------ "REVIEWED=BY--------------------------------•------------------------------- ------------------------------------------------------ DATE-- •------------------------------------ rt E _ _ �Y BUILDINGPERMIT 1LIED---------------------------------------•---------------- ----------------- -------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------- -----------------•------ ------ --------------------------------------••:•---------------- ------- ----------------------------- --------------------------------------- -------------------------------- ----------------- -------------------------------------------------------•--------------•-----------------•-------------------------•-•--•--------•- r --------------••---------------------•---------------...-.---...----------------------------------- ---------------•--------------------------------•------- -------- -------------------------------•---------------- -------------------------------------- --------------------------------------------------------------------------- ----•----------------------------- --------------------------------°-------------------------------------- -----------_________________ ____....._---_....._.______�M__-__________._._._--_--- �____-__.-__.__--__.__.-.-___..ti________._ _____.._...-___-._____________..".______..__i______________/__ _ .____.__--__._ FINAL INSPECTION BY:-------- - e �--- -----•--- -- --------•- -------=------ Date----------------------------------------- --------~----r-----------•- 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 t ¢S 9 REVISED 8-59 3M 3-'63 F.P.CC.