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FOR OFFICE USE: r_. APPLICATION FOR SANITATION PERMIT Permit No. --------------------------- -------------- -------------- L ---------- ------------- __ 3 _ (Complete in Duplicate) Date Issued l .__.._--_---------:------------------------_------------- 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. JOB ADDRESS AND LOCATION--------- �`2�------- !' ----------------------------------- ---------------------------------------------------- Owner's Name-----------z.1kt1,!qPZA1 .........C-.4-: .. - = = Phone_ Address :.._.. ------------------------------------------------------------- ' ----------------------------------- ---- Contractor's Name-- - /---- ........./f--- ------------------------------------------------------------------------- t Installation will serve: Residence ] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�_/_-_ Number of bedrooms -,,3._ Number of baths _I____ 'Lot size ________._________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _� ft. Character of soil to a depth 41/3 feef- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob/eb Hardpan ❑ Previous Application Made: (If yes,date---------- --- -----1 No New Construction:. Yes ❑ No FHA/VA: Yes [] NoI)l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) { Septic Tank: Distance from ncfa est-well-----------------Distance from foundation-------------------Ma+eriaL__..________________.___._________..__________- ❑ �,,,,,�i..h:..?. No. of compartment-s- -------•----------- -----Size--•----•------------------- ---Liquid depth--------------------------Capacity------ ------ f Disposal Field: Distance from nearest weli_A49zY�5L:Distance from foundation........ _'_.____.Distance to nearest lot line__-_S_j....... Number of lines---__f-__-.: _____------------Length of each line---------17 Q-_'_--._.-.-.Width of trench--------- _ G Type of filter material____ ,__Depth of filter material-----AP�-____Total length_________._________ S Seepage Pit: Distance to nearest well---------------------- from foundation____-__-.._._.___.Distance to nearest lot line__.__.°___.__..__ ❑ Number of pits--------------.-----Lining material-----------:-----------Size: Diameter------------------____.Depth--------------------------------- Cesspool- ---------------------:----------Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining " material_ _____________________'____.__-_. ❑ Size: Diameter - " ¢ De th="t__� -- -_-___:__ _--Liquid Capacity = gals.° -' "° _ ___.-_._.: -Privy: a Distance from nearest well-------------------------------------------------Distance from nearest building_. ..,,_.-----------------------.-._____. ❑ Distance to nearest lot line--------------------------------------------------- ----- Remodelin and or�r airin '(describe); � .__ /�5 /✓✓ ___-s� _XZTE _ a e�__________45_'___� Remodeling p 9 ) r r f ,PGI • t = = - � nG�>/1> �[lrzrs SPT rp<t _r -------------- .. � '✓k i+a' = e t�sa= --------------------------------- :._.. �y 4 ___-------------------------------___________S_.__________________I--_____________-_-_._.___.-___________._____________________________________. hereby certify.that•1 have prepared this application and that the work will.be-done in accordance with San Joaquin County ordinances, State law , and rules and r;gulations of the San Joaquin Local Health District, f (Signed) " � l�7 / Owne and/or Contract or) .. $y:---------- ---------------- •-----------------------------------(Title)-------��fF --' ....... ............. .........---- -- (Plot plan, showing size of lot, location of syst in relafion to wells, buildings, etc., can be placed on reverse side). IF FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------------------ DATE------e GW/41-- ------'r- Y----------------- REVIEWEDBY---------f-i--------- t ------------------------------------- DATE----------------------------- BUILDING PERMIT ISSUED ----- -------------—-------------------------------------- DATE-------------------------- ----- ------------------------ Alterationsand/or recommendations--=---------------*--------:------------------ -------------='-------------------------------=--------------•----------------------------------•------------ s [ , # a ---E -------------------- ----------- -------- �--;--;-;; - - ;-;�-;----------------------------- -------- { -------------------------------------------------- ------------------------ ------------------------------------------------------- - --------- --------------------------------------- ---------------------------- ----------------------------- ---------- -------------------------- ------------------- ---- ------------------------------------ ----------------- -- - -------------------- ----------------- l FINAL INSPECTION BY: :-:----- -- Date �� � ; f� 6 h • � i 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 ES 9 REVISED 8-59-3M 3-'63 F.p.CC.