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FOR OFFICE USE: Zl ,-020/1 ` APPLICATION FOR SANITATION PERMIT Permit No. .. (Complete in. Duplicate) / - _ : Date Issued ___ ......................................................... 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 herein described. This application is made in compliance with County Ordinance No. 549. ` 8�q�p W.. JOB ADDRESS AN . LOCATION__ (= ---. _.__._ �J` Owner's Name - ya L/`cl ' ----- ------------------------------------ ----------------------------- Phone------------------------------------- Address-------- �-- ........ ` cr�.c ?..�' �: - Contractor's Name-----------•--------•--. l--------------------------------------------- -------------------------•-•------- ._._:_...... Phone----------------------------------- Installation will serve: }Residence ❑ Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑l Other ❑ Number of living u -------------------------- Number of bedrooms__`7`'Number of baths __��Lot size -_--__ _��.Sl_._ .________________________ Water Supply: Public system ❑ Community system Private F-1Depthto Water Table -------- f#. Character of soil to a depth of 3 feet: Sand ❑ Gravel❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [j Previous Application Made: [If yes date__.___..__,__-. ---), No New Construction: Yes ' No E] FHA/VA: Yes ❑ No 4 TYPE OF INSTALLATION-AND SPECIFICATIONS: (No septic tank-or cesspool permitted -if pu��b ++lic seyKer is available within 200 feet) Septic.Tiink: Distance from nearest well----- /-?-uistance fromfoundation----------------- Material . _ _� ------r � � -_ - ---. of compartments-------- ------- - --Size----- -/-!2 ___.__._ Liquid depth-------= -------=.Capacity----1----U------- Disp sal Field: Distance from nearest well.... ista c om ound tion. . �i_0:.__-Distance to nearest lot lin _________________ U Number of lines_- •--'-- -_-- "Letigh o each me__________ __ _____7-�--..Width of trench,,, Type of filter material_ r.��.Depth of filter material------f_�_-_____ -Total length_--- ' ------ ,ZS'o Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance o near lot Ii e---------------- Number --_ .-__._--._Number of pits---------------------Lining materia€_----------- -----------Size: Diameter----------------------Dep n--.------.----------------------- Cesspool: ---------------------- i -- - ._-_-- __.... _- -- Lining materialy----------------------- ls, ❑ Size: Diameter - Depth = Liquid Capacity----------------------------gals. ass oo : Distance from nearest we ____----.__-_--Distance from foundation-------------------- Privy: �_ �,.r Distance from nearest well---------------------- ------ ------ Distance from neares'building---------- ------ ❑ Distance to nearest lot line ------------------ - ------� 4 ► AD rK Remodeling and/ reaidhg (des r e) __ ---- l ------------------------------------...... --------------------------------�---i[:• cam :l - 71� r m Y ;. _. A -s .So.C7 } I hereby certify that I have prepared this application and fhat the-work w ire done in accordance with San Joaquin County ordinances, State laws, and yles and regplations,of the San' Joaquin Local Health District. (Signed)-----� ------ ----�- - .? -_Owner and/or ontract y . By: -------------------------- ----- - ------- ------- {Tit e}------ --- ---- ---- - ---- -- ------------ (Plot plan, showing size of lot, location of system in relation-to wells, buildings,,e#c., can be placed on reverse side).. i FOR 11EPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- ---`-------=------------------------------------------------------- DATE-------------------------- ------ --------------------------�4 REVIEWEDBY--------------------------------------------------------- r---------------------------- --.----------- DATE--------- ----- OO BUILDING PERMIT ISSUED — I � DATE--------- �`� �� Alterations and/or recommendations--------------------------------------------� � �/-------------- -----------------••----------------------- ------ h --------.-------•-------------------------------------------•-----------------------------------------------•-------------=---------------------------------------------------•-----------------•------------------------- ------------------------------------------------------------------------------------ ---------- ------ ------•-------------------------------------------------------------•-------------------- -------------------------- -------------------------------------------------------------------------------- ----------------------------•--------------------------------------------------------------------------- - -- ----------------------------- _ -------------------------------------------------------- ------------ - -- ----- ------------------------------------------------- ---------- --- ------------- ------ ----------- FINAL INSPECTION $Y:.. ------ Date----------------=--�d SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REV75EG 6-54 3M 3-'63 F.P.CC. -