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f; FFICE L1SE: ` -7/ �U APPLICATION I FOR SANITATION PERMIT Permit No. ... ------------- ---- ----- ----------- --- ------------- (Complete in Duplicate) -_.--- This permit Expires 1 Year From Date Issued date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrbed. This application is made in compliance with County Z47 No. 549. JOB ADDRESS AND O ATI 0N-_ --- -- -dq�r.-- -------& ti---- ------- ---•.�� -- -� Owner's Name/------- - �/-' --r•f�� - -��-�� -------- ----- --------- --- Phone------------------------------------ Address-------,/--- j--l�_._-----� ' � ---- UIL � --------------------------------------- Contrac:tor's Name-----�� --- -- ..... Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other (] Number of living units: Number of bedrooms Number of bathsl _ Lot size _______________________________ Water supply: Public system ❑ Community system ❑ Private 2-_`6epth to Water Tableeq 4/_a_ ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®Hardpan ❑ Previous Application Made: (If yes dote.__ ___ ° _ ...--) No ❑ New Construction: Yes �o ❑ FHA/VA: Yes 9,-*o ❑ TYPE OF INSTALLATION AND SPECIF(ATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic 'frank: Distance from nearest well---Distance from foundation---/9---------Material__�_�_ff,; '!�y No. of compartments___ s9.. .--/._size-4:5--- _{P _Liquid depih--- /% -..-_____-_Capacity__s Disposal Field: Distance from nearest well___ _ ------Distance from foundation----/�-_.-__Distance to nearest lot line-,-,----'__----- O Number of lines__________________ Length of each line------ .- ----._. Width of trench.__. _._____________.__._______.. Type of filter material__ ..__Depth of filter material----le-.__--_.__Total Seepage-Pit: Distance to nearest well-__/�Q_-.-'.Distance f om fo ndation-__ � � �j ,��_____..Distance to nearest lot line---��__._ Number of pits_..__.----------Lining material-/�� ---Size: Diameter_19!�<-_-_.-_-_Depfh��!.______-____---- Cesspool: Distance from nearest well--------------___Distance from foundation _-----_Lin'sr�g material-._.----__--.�_.._--__-._.-_--__-_. Size-Diameter__--._-------------- ----------Depth--------------- Liquid Capacity �-----------gals. , Privy: Distance from nearest well ------------------------------------------------Distance 'from '6&arest building-�___.....':__-- .---__---. � ❑ Distance to nearest lot line = ------------------ ------ ------------I----------------------------- ------ ---------------------------------------------4---------- Remodeling and/or repairing (describe):------- �ate' i ---------------------------------------------- —_- - - �..---- _,—,-----...-�------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------� -- -----------------------------------------------------------------------•--•--------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 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. [Signedl--------•-`4-155- --y� � -�in �elafion ----------------- ' r-art4for Contractor) ' --------------- -- I;y:-----------------= ----- r1 -------{Title) .�. '� '------ --. .. ----- -------- (Plot plan, showing size of lot, location of sys to wells, buildings,_efc., can be placed on reverse side). FOR DEPARTMENT 115E ONLY APPLICATION ACCEPTED BY---- -------- ------------------------------------- DATE------ . --- REVIEVVED BY-------------------------------------- -. DATE------------------------------------- LDIPJG PERMIT ISSUED DATE - Z[ C. �_ �syt_ lr-z t� v�L . Ulerations and/or recommendations. -------��.-----�z------Tri -- ------------------------I -----------------=------ - - ----------- ---�--------------------- -------�-------- - ------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL- INSPECTION BY--------------- r-'- -- --- Date ----- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED B-59 31A 3-'63 F.P.CC.