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FOR OFFICE USE: ' J ` .i� APPLICATION TOR / S - SANITATION PERMIT Permit No. ... z' 11 ---- - -- _ -. _(Complete in Duplicate) w - Date issued .___...�,z __llry ---..___________ -------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereinescribed. This a 4. lication is made in cam li nce.with County Ordinance No. 549. t JOBADDRESS AND O-�CATION_ ------------ � 01 Owne. Name-------•'54 ---------------------------------------------------------- ------------------------------------.-. Phone--------'_--------•-••------------ I ------------------ Efl --- ------------------------------------------------------------------------------------------------•------------------- Addressi Contractor's ----------------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: -1---- Number of bedrooms _-A-- Number of baths /------ Lot size ------------------------ ----------------------------------- WaterG Supply: Public. system.❑ Community system El Private [P Depth to Water Table 3Q--- ft. Charm ter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [] I Previol Application Made: (If yes,date--------------------) No EE, New Construction: Yes No ❑ FHA/VA:Yes F-1 No ❑ TYPE SOF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)11 - Septic!Tank: Distance from nearest well_!'"a---------Distance -- from foundation-_!fl-___.- ---.M aterial----- --------------- q-, ------ ------- No. of compartments......��---------------Size--- --------Liquid de th-_-_ Capacity./X-tom__-.-_-_-_-_--- - Disposal _ Field: Distance from nearest well._ A_ ------Distance from foundation.__l9_____------.Distance to nearest lot line.--%!r'........ Number of lines_-- --I------------- -.._- ---Length of each line------Z_&7 ---------------Width of trench--- _Y ____..--_- .--_---._ W ®' Type of.filter _ _ _ material Depth of filter material_./�'_- Total length---I(_o . -------------------------------- V1 Seepage Pit: Distance to nearest we 1_____________7:_______Distance from fou: .ndation---_..._-______----.Distance to nearest lot line----------------- Number of }pits----------------------Lining material----------------_-------Size: Diameter------------.----------Depth_------------------------------ l. ❑ - ,. r Cesspool: Distance from nearest well-------------':_Distance from foundation-------------------.Lining material _________.._____.___._`______.__. ❑�l Size: Diameter.:=-- ---------------------------Depth----------------_------------ ----------------------Liquid Capacity -----------------------gals. x Privy: Distance from nearest well--------------------------------- '--------------Distance from nearest building-----------------------------------..----- ❑ Distance to nearest lot line---'-"--------------------------------=----------------------------------------- ---------------------------------------------------- Remo eiing -•------------------------------------------------Remodeling and/or repairing (describe) -------------------------------- ------------------------------------------------------------I--------------------------------------------- ------ ` y i- --------- =----•-••------------------------------- ---------------------- �i .. _ -s --------------------------------------- ---•---•-------------------------------------------------------------- ------- ---------------=-----------------------•-•-------•--•------------------------------------------------------------------------------------------------------------------------------------.:.-:------------ 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. , / (SignAll- ----- ..`-`_ _._. � -.- 24'a------ ----.-----------(Owner and/or Contractor) � BY: f�^f ----------------------- (Title) _. -' .:. (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-: , er�a, - -- ------------------------------- DATE_-rs_-_/+ _ Y-1- REVIE]NED BY------------------------ --------------- ----- ---------------------------------------------- DATE------------------------------------------------------------ BUILDNG PERMIT ISSUED---------------------------------- ------------------------------------------------------------------ DATE------------------------------=----------------------------- Altera-ions and/or recommendations:----------------- ---------------------------------------------------------------- -------•-••-----------•-------••-•------------------------------------ da --- ---. ------------------------------------------------ -------------------------------------------=- FINAL INSPECTION BY:- --------------------- Date--._ .-� ��-"-C�- ------ -..- . - -- l r SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9.REVI=SED 8-59 31A 3-'S3 F.P.CD.