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T FOR OFFICE USE: f - -----j-----� --- --- ------ -�--�'j---- �---- --- Permit No. --- `It—`"r' APPLICATION' FOR SANITATION PERMIT (Complete in Duplicate) Date Issued -----J_ z/ _y ----------- _ ---- -------------------- ; li This Permit Expires 1 Year From Date Issued Application is herebymade!kto the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. �I -------------------------------------------------- Phone------------------------------------- Owners -- - � Z `� - JOB ADDRESS AND LOCATION-------•---fes — e�r�u'` /�tl�� ------ __-_-- Owner's Name--- - - ---- Address ... tl - ----•-•-- �------- Contractor's Name---------------------------------------e------------------- '_ _ Installation will serve: Residence �artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El E i r ------ Lot size ..�/-�-�-.�-_. --• -----------•-------------- Number of living units: __.f-_ Number of bedrooms __ Number of baths Water Supply- Public system p�mmunity system El Private ❑ Depth to Water Table ._`__ ft. Character of s99t ,,a dept of 3 feet: , Sand E] Gravel E] Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe Hardpan C] Previous Applidaticfn Mad �st {If yes,date v�l-� --17 .-} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ - No [ITYPE OF INSTALLATION I AND SPECIFICATIONS: (No septic.tank or cesspool permitted if public sewer is availabke within 200 feet.) 7 Septic T nk- Distance from nearest well._____' €distance from foundatioMaterial________________________________________________ ❑ �j .-„G�' o ofl�compartments-------------------------Size--------------------------------Liquid depth------ ------------- --Capacity --------------- Disposal Feld r7/ Distance from nearest well._______--_.___.Distance from foundation--------------------Qis#ante to nearest lot line..______._______. t Numbelr of lines----------------= -------- - -Length of each line_ r. _._Width of trench.-. -: �-,------------------ a�CC� f filter material_____ I �Depth of filter material____.__ '-------Total length_____-. -----=-------- - f -------- Type op tline. .r )I Se4age Pit: Distance to nearest well__a�_._ Distance from foyndation_____ tj_______.D ta7ce to nearest lot line_____________-_._ — i p e �s-z" -C. _.Depfk------ cr----- ❑ Number of its._----- _------ - - Linin material_ __ . -__- ize; Qiameter_. � Cesspool: Distance from nearest well________________ Distance from foundation__.._..._..___._--lining material,._.____.__.______________-_______ i _Liquid Capacity----------------------- ----gals. 0 ❑ Size: Diameter----------------- --------------------Depth--------i------------------------- --------.--- - g Privy: Distance from nearest.well------------------------------------ Distance from nearest building-------------------------,---------------- ❑ ' Distance to nearest lot line----------------------- -- - ------ ------------------------------ Remodeling and/or repai ring (describe):--------------------:--------------- --------------------------------------------- ------•----•---------------------------------- ------------------------ -------------- ��----------------------- ---•-------------------------- -------------- �I� - - ------------ -- I hereby'cerfify that'd brave prepared this application and that the work will be done in accordance withan Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 ----------------------------- Owner and/or Contractor) [Signed)_ _ , _ .�.c1�� --- -- ---- ------ ---- --------------------- -- l B showing f `- -- ----- -- -------------------------- ----------s----------- ------(Tit e) - ---------------- ---- - --- -- - (Plot pian, g size o'blot, location of system in relation to wells, buildings, etc.,.can be placed on reverse side). FOR DEPARTMENT USE ONLY I �y: APPLICATION ACCEPTED BY_.._ --------- rr - DATE f ...� DATE------------------------------------------------------------ REVIEWED I. BY--------------------------------------------- ------------ ----- - ------------ -------------�-------: -- -------------------------- ------••- Alterations and/or recommendations: DATE--------- - - -- --------•-- ------------------ -------------------- --- ----- -- r� mendations: E - -z,- ----&7-.c---a.----- o BUILDING PERMIT ISSUED ---------- I ------- - - --------------------------------------------- II _ _ ._______._ ------------------------------_---_._______.___-_______.___. I _ __________________________________.-.---_____-_..__-______._____.__. _____.__ ________..._____._.__._____ ---------------------------- A ____________________________________________________ ____________.__-_____ ___________ .___._.____.___._. - � � � FINAL INSPECTION BY:-- `�Z - ------ ,. 3. Date r = AN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Ha:eiron Aw, 300 West Oak Street 124 Sycamore Street 205 West 911h Street Lodi,California Manteca,California Tracy,California Stockton,California y,Y ES 9 REVISED B-59 3M 3-'63 F.P.CQ-