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FOR OFFICE USE: !/ i -------------=---0-------- / APPLICATION FOR SANITATION PERMIT Permit No. ..l..._Z_6_..'73 L ------------------------------------------------------ (Complete in Duplicate) L _ This-Permit Expires 1 Year From Date Issued Date Issued __. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i' This application is made in compliance with County Ord'innanncce�,No. 549 JOB ADDRESS AND LOCATION- IVO may/F Owner's f Name- -------- - --- - --- ---- - -f----------------------J- --------------------------------------------------------------- Phone----•-----------------•------------- Address. ---- - ---- ----- -----------------------------------------------------••-------------- ----- ----------- Contractor's Name............... - J -------- Phone------------------------....... Installation will serve: 'Residence Apartment House ❑ Commercial ❑- Trailer Court ❑ Motel ❑ Other ❑ 3 Number of living units: __/--__ Number=of bedrooms,_ *Number.of baths _/_.-. Lot size.__ �j_______________________________ Water Supply: Publics stem Communit system Private Depth to Water Table _ PP Y� Y C❑ � Y Y ��.�❑ P XIft- Chara_cter of soil-to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe lZI-IFIardpan ❑ Previous Applicatiori'Made: (If yes,date------__-_-, � ___-� No Er'_ New Construction: Yes [L}/qo ❑ FHA/VA: Yes Pg--No ❑ TYPE OF INSTALLATION AND SPECIFICATION'S' t ANo septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic T k: Distance from nearest well____~�___ Distance_ from foundation__,�r�__--4:9 --.M tefi�___ No. of compartments______----------------- _____Liquid depth___ Capacity__d- 774_______- ------------- Disposal eld: Distance from nearest well Distance from foundation:"'�..__. /(�-__.._._.Distance to nearest lot line__..r--.'_.____. Number of lines.__.__'_-Z_-7n_�______________Length of each line______ '� .z Width of trench._2.�............------------- o Type of filter material__` f4&epth of filter material.-_- Total length___A:�_.Q________________________ Seepage it: Distance to nearest well ______________-------Distance fr m fou dafion---7/.�_........Dist Distance to nearest lot line-----__�__.._ Number of pits------cr2-__:____:__Lining material-_/ X.Size: Diameter_&___ _ ______Depth_-��._______-_______ • 00 Cesspool: Distance from nearest well_________________Qistance from foundation.-_.__--------------Lining material-_.__.___-_________.____._-_-_-...._. ❑ Size: Diameter---------------- -----------------Depth- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_________________________________________________Distance from nearest building----_-__________________________---___-_. ❑ Distance to nearestaot line - ---------- Remodeling and/or repairing (descriiie):----- `- 11/--- ---- --- + -------------------------------------------------••----------------------------- ' -----------------------------------------------------------•----•--•--•-------- ------------------------------------------- -------------------------------------------------------------•-----•----------------------------------------------------- ._------------_------------------------------- 1 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. I (Signed) ) = -------------------------------------------------( or Contractor) ✓ i (Plot plan, showing size of lot, location of s in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY--- r DATE '' �� l REVIEWEDBY------------------------ --------- --------------------------w----------•-------- =- ----------------- --- DATE---•----•---•---•----------•----------..-•------------- .. BUILDING PERMIT ISSUED----------- --------------------------------------------------- ------ DATE------------...__.-------------------------------•------------ Alterations and/or recommendations:___-*_ ______ __ _ - - ---------------------------_--------------------- . - r r------- - =- 2� =ice � `+ s :. --------------------------------------------=-------- '------------------------ f ---- ' -._.-.------------------------------------------------•-•-------.--------- FINAL INSPEC�I �S� -- - Date / l - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street �124�Sycarinore Street 205 West 9th street 1 Stockton,California Lodi,California Manteca,California Tracy,California EB-9 RMOrD B•59 T.P.r D.$M 0•60