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FOR OFFICE USif- / ------------ --------- -------_ _ _ APPLICATION FOR SANITATION PERMIT 'i .__ _ _ (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. t 4 ' - -ti .w- a -------- , 1-�--JOB,ADDRESS AND-LOCATION: � } �� """""` Q Phone Owners Name"""'"---- ' �� ---- ----- _.w�. x 7 ; Address_--•- --••=----- �-a __ -------•--------•-----••- ------------------------------- r - ------ ----- Phone---_------------------ ----- Contractor's Name--------- --- - - --- " n------ Installation will serve: Residence �Ap artment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ = i r , ._.. .c]---------------=---- I # •3_ Number of baths - Lot,size �d a_ -f-Q ` N�umbertof living units:.___1____'Nu 6 4er of be s Water, Supply: Public system Community system ❑ Pr�f De tli fo Water"Table ""ft Character;of soil to a depth of 3 feef: Sand Gravel ❑�Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ 't , ' ' Construction: FHA/VA: Yes �No ❑ - [ T _ i Previous Application Made: (if yes,date____�.-:_,4__..y) No New Yes _ No ❑ 4 .�TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available-Within 200 feet.) /V Material-C-0 ------. Septic ",k: Distance from nearest well- .� =__Dist ce from foundation"_�_ - No. of compart67 CD ments-------` ---------Size._ uid depth--- ?------Capacity--1 ---- ��-__-_-___Distance to nearest lot line`-_ ; Disposal Field' Distance from nearest well. - _" Distance from(foundation_ . __ ._ Number of lines___----t' ------------------Length of each line--_ff-�-��-� ��-Width of trench._._____j�_- �_..�------- `� Type of filter material._ t. -Depth of filter material____._("�-_-......Total length---___._-__--- 1 p ge Pit: Distance to nearest well ----------------Distance fromfoundation____.____._____.___.Distance to nearest 10# line____._--______._ 0 Seepage Number`af'pit ""L'irifrig'materialSizeDiameter'" --------------Depth"------------------------------ Cesspool: Di�tance from nearest well--._._--_ _ Distance from foundation __ -_ --_-_ L'inin material------------------------------------- Cesspool: _______ ____ _____ __________5 91W =_ �, -De th �4 '�'"' Liquid Capacity ."--------------- -----gal ❑ Size: Diameter -__•�-„ : p ..: r�-�"� �� „�• � : , Privy: Distance from nearest well--------- Distance from nearest building.--_. .-----_--- ------- ----- ---- --- ❑ Distance to nearest lot line.------------ ---- -------------- Remodelingand/or repairing describe ----=--------------------••------ -•-------------.'------------- ----------------------------•----- _________ __________________________ ______________________"-_4'__._-------_-__-----__--_-__-_--__"----_--_----------_-_---.-----------.------------.-----_.__4---------------------------_--------------.___---.-_.------ _".-------------------- --------------------------------------------------------"___---_-----._-----____-__--_-_-__--------____-__-_---..__________f/1_-__.___.___. __________._._______.____________V--_--- - _ _ - ------ ------------------------------------------------".-------------- ----------------------------- ____;---_---_. ____--_._-_____..___.___.______.____________.__________. __._.____,______..._ ------------------------" ---_- - _ - I hereby certify tiaf I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws!and'rules and regulafionsl�of the San Joaquin Local Health District. C' - (Ow Contractor) r and/or i — (Signed)-=-- -----_-- ''� ��.: '��_ _ �-:. - --- --- -- -- .. -:-- m i - ----- -- (Title)---- --- ------ - -- ------ ---- -- ---- - BY:-------- -------- n (Plot plan, showing size of lot, location of system in relation to we lls;.*builodings; etc„ can be placed-on reverse side).. �. FOR DEPARTMENT USb bE ONLY d �7 y ------------------- ------=-------------------------- - DATE----_.. ti.N,r•-�:----f-------eA -----�---------- REVIEWED BY-------------------------------------------- ----- ------------.----------------------------------- ----- .. ......................... .. .. BUILDING,.PERMiT,155UED----------------- ---------------------------------•---------•----------------- ----•- DATE---------------- ----------- ------------------------------ Alterations and/or recommendations:__._- - -------------- ---------- ----------------- ---------- .r,- ; a '�q +s..r. ,. R.�_ ��.�_�'_"'�_._._._. __---------------------....... __..______ 11 i ..........-------------------------__-_--__-_._ ________________ _ _____ FINAL INSP ,. " ----------- � Date-- 1- -7v '-------- --------- 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 REVIg EO 8-54 3M 3-'63 F.P.ED. ,