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R,,0fffICt USE: a - -------------------- ----------------- ------------=----------------------- '` _ .____.________ (Complete APPLICATION FOR4 SANITATION PERMIT Permit No. S v•- - - Duplicate) , 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 wor herein described. This application is made in compli ce with County Ordinance No. 549. Z2 5"SS-E ��t-Q r,j �- ii JOB ADDRESS AN LOCATION lE?C`r� d- L_ - ------ -------------------------------------z`f�•---d30��3 OwnersName---------- -------- ------------•------------ ---- -------------- ------------•--- Phone-----.._---•------------------------ Address------------ 7 �C------ --------I ------� --------1 SCp1L�f� . - - - - - -- --- - Contractor's Name--------OWNE-+_Z_ '---------•-------------------•----------- -------------------------------------------- �---------•--- Phone.-----•-----------------------•---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E3 Motel ❑ Other L]_ Number of living units: ---.- Number of bedrooms -f- Number of baths -R _ Lot size ----- ______________ IT Water 'Supply: Public system ❑ Community sysm C-] Private,?f�Depth to Water Table30 ft. Character of soil to a depth of 3 feet: Sand J Gravel E] Sandy Loam F] Clay Loam ❑"Ti`Clay ❑ Adobe❑ Har pan ❑ Previous, Application Made: {1f yes,date---------_.........) No R!r'-- New Construction; Yes ENo ❑ FHAA Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200'feet.) Septic mak: Distance #rom nearest well---- ----Dista e from fou dation__.__©.___.__.M terial-- _Gr -------- POO No. of compartments_---- -----------------Size_%X_]V_x___ Liquid depthCay_..._r' Disposa�Field: Distance from nearest well+__S7___-_Distance fro oundajion.__�Q__-__._!Distance'to nearest-lot line__--i�`~ Number of lines-___--- _-----_-__.;.-__-_-Length of e c line_ Q --. 'idth of trench`' �i_'� _ �I.__ Type of filter maa&rial__ROL_K___Depth of filter material-----;<_9...........Total length_ _ ---/ Q-- 1 Seepage Pit: Distance to nearest well----_-_____-_______Distance from foundation------------------"Di"stance to nearest.lot line-------------K---- . ` ❑ Number of pits----------------------Lining material---------- -----------Size: Diameter-----F_1------- ----Depth--------------------------------- Cesspool: Distance from nearest well---------------___Distance from foundation--------------------Lining material-------------------.------------- .__. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. )t Privy: Distance from nearest well-------------------------------------------------- from nearest building------------------------------------------ Distance to nearest lot line_______________________________________________ ❑ ------------------------ ------- = - 1_ - -------------------- Remodeling and/or repairing describe - - i--------------------- --------------------------- ------------------------- --•- --------••-- .. S -------- ") ------------------------ - 31== ��''�--- ---- ------- ---- 0------ Roan- , -----------------------------------------------------n2Q�}_4-.m--------o.�.F------_� L _ — -------• IQ f a�DRa ----- ---------------- -- ----------------Sv_.t_ _.---- 1,E -•------C4(J_ ------ _tV-Q------------ 6 - ------------------------------------ I hereby certify that I have pr'e'pared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and regulations of the San Joaquin Local Health District. , Y (Signed)_----- - -- (Owner and/or Contraco ------------- By:--_--------------•---•--- ----------------------------- ---------------------------------------------- -------- --------- ----(iitle :-- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y ( 1 `� ---' - -'--� ...._ � - � DATE; �r�� s'r REVIEVI/ED BY----------------------------------------------------------- ------------ ---- --------------------------------------- --- DATE---�------------ F BUILDING PERMIT ISSUED-:--- ------------------------------------------------------------------------ - ---- ---------------- DATE------------------------------------------------------------- Alterations and/or recommendations:----------.--------_ - i •- ------------------ ---------------------_----------- •----------------------------------- --------------------------------------------------------- --- - .. -----------� � _- -- ---- ------ ----------------------- --- ---------------.-- ------- � FINAL INSPECTI -- - ----- ------- Date------ ( �`� - 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 {' E5 9 REVISED 8-59 3m 3-'63 r.P.CD. ■