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jPR OffICE USE: --------------------------- ----------- ---- --- --------------- --------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No, ----- -------------------------------------------------- --- ----------------------------------- I This Permit (Complete in Duplicate) Date -issued Expires I Year From Date Issued _d/ 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. 0 C 15).%_= 9 - 0 M, ��J'OB ADDRESS ANL N"'" _Rb------- ---------Pit--) - J�LOCATIO ---- OCATI _.� A�10/v� ------------ Owner's Nor e---•----- ------ a, _,.6AR_F lvu)---------- ------------------------------------- Phone------------------------------------ ------ KX Address ------ ... ..... ---- -------f-3-6 •E -l----------Al r J --------------------- Contractor's Name------ ----------------11-----------------------------------------------------------------I------------------------ Phone-_---------------------:......... Installation will serve: Residence Apartment House E] Commercial [] Trailer Court E-] Motel [] Other El Number of living unifs:7j,'____ Number of bedrooms _'A� Number 0 baths ---- Lot size .-Ac -_--------------_---_ Water Supply: Public system (j Community system [-I Private [E] Depth to Water Table f.. Character of soil to a depth ofi3 feet- Sand Gravel [] Sandy Loom [] Clay Loam E] Clay Adobe 0 Hardpan E] Previous Applicafio; Made: (IfI yes date-_----__._-._._...-) No P' New Construction: i ..._Yes No E] FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest w �T��----Distance fro foundation/ ---------------------- - ----------- M�f No, of compartments..____._--------size---73_X57x6;>_ZjLiquid depth---- K Capacity_, �%------------ ----------- Disposal Field: Distance from nearest well_-- ----Distance from foundation----/.0--------Distance to nearest lot line._ Number of lines----- ---Length of each lin're--------3 el--------------Width of trench-------- -0--------I----------- Type of filter mate ------Depth of filter material----- ----Total length------------ -2-0---------------- '4— C01-VC T-L Seepage":Pif --Distance'to'nea-re§rl�f t well is once from ,foundation___________________'Distance to nearest lot line--__---.---_-__.: Nu_rnber of pits�-------- Li I I uf-e-�idl-" EJ% I n I n,'g _.Sile. Diametere----------------- ---------- -A----------I------ Dista nce,f rom,.nea resfwel ------Di�sfa_n from foundation___..__________---I . 1. r I ce , --- Lining material-___._._.-__--._---._-___------------ --Size: Dianne'fc-r�7--___ -----Depth- -------------------------------------.-Liquid Capacit - ------------------------- -y----------------------------gals, Privy: Distance from nearest well--------a------------------------- ---------Distance from nearest build ing-_14144!730 ❑ Distance to nearest.lot'lihe:......�-7--____ L, _W Aq - ----------------------------------------------------------------------------------------------------------- Remodeling and/or' repairing (describ):----BROf.�. .E ----- K —----- ------ ------ ------- ---:54W-R_c --*------------------------------•--------------------- ------ -- -------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------)--------------------------------------------------------- -------I------------------------------------------------------------------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfa+e laws, and rules and regulations of the San Joaquin Local'Health District. (Signed)- -- ---- -------------------------------------------------(Owner and/or Contractor) ---------------- ------___-r-=-------- ---------------------------------------\--------(Title)-----------------------2--- ------------------------------------- (Plot plan, showing size of lot, lolc6tiofi'of system,-, in relation.fo��ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ... ...7------------------------------------------------------------- DATE----- ��/------------------------- REVIEWEDBY--------------------------------------------- ---------------------------------------------------------------- DATE--------------------------- ------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------- -------------- Alterations and/or recommendations- ------------------- --I.................. ------------------------------- ------------------------------- --------------------------1---- --------- -------------- ------- Wi Li__ 1>------ ------------------------------8-F—------FX4 ------- -- - --- ---On- -- C%-7to ----------------------- -------------------------------- -------------------- r --------------------------------------- ----------------- ------------------------- ------------- ........ FINAL INSPECT ------------ -- ------------------------Date- 77'__2-X_-7-I / SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Callfornin Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 21-6:3 F.P,Co.