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rFOR OFFICE USE: _ _- 1 ------ Permit No. . _ _� -��- APPLICATION FOR SANITATION PERMIT 1/-��•--��-�-"��/ ------ --------- -------- ----- '% (Camplete.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. f �f JOB ADDRESS AND LOCATION..--�JT-��-----'-'---� ------------------- ' --------- ---------- Owner's Name-- `/- ----------- ----- --•-----• ------------------ -aa ---------•------ x - Ph -aa 7�--- r ---�01--------------------------------------- Address-------------. - fContract is Name---- z5--------------••----------- ---------------------------------------------------------_ - :.. _` Phone • .. Installation will serve: Residence E —Apa7tment House'❑ -Commercial ❑ Trailer Cour# ❑ Motel ❑ Other ❑ Number of living units: ____t N ber of bedrooms -_� Number of baths ---1--tot.siie .¢Z077` -�--�---------------------- Water Supply: Public"system Community system ❑ Private ❑ Depth to-Water Table::�� f#. I P P Y �'. l Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑' Adobe n--Hardpan ❑ Previous Application Made: llf yes-,dot e.....................) No New Construction: Yes T No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS- i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I �_ Septic nk: Distance from nearest well__-------------Distance from faundation__,f.a:-__._._--Mat�rlal___�(.�_ _- -.-- _� �p No.�of compartments'------f-----------------Size_3_A_ 7_X,__7----7.Liquid depfh=_ 1�-------------------Capacity-r------. Disposal Field: Distance from near + well..�-----_._Distance from foundation..14F__-.----+ .Distance to nearest lot line----------------- s [� Number of lines-------------- ------------------Length of each line_.1��_~-._ Q".' A4Width of trench--- -9:._------------------ 21--- ----------- Type of filter material--_�'� __--____Depth of filter material._l_�"-_---_-_Notal length____P1Q-__`__-:--- I - i Seepage Pit: Distance to nearest-well----_—-----------Distance from foundation__-0-----..___�Di�pce to nearest lot line.�-___-_-.- � s 0/ Number of pits---,l-----------------Lining materia`�COC-_k'__--.Size: Diameter____ ________ __......Depth--- Z.LL---_ `-------- f , .. Cesspool: Distance from nearest well---__--___---._-Distance from foundation_---_-----_-__t47�Lining material_____________________________________. Size Diameter_ ` ----------------Depth--- ------------- ----------- ------------------_-Liquid Capacity----------------------------gals. Privy: Distance from .nearelt well------------------------------------------ ---Distance from nearest building--_E__- ------------------ ------------ s -{ ",❑ Distance to nearest lot line------------------------------ ----------------------=•------------- rn �{ I Remodeling and/or repairing (describe):--------------------------------- --------------------- �-- ------------------------------=------- - I ' - -----•------------------------------------------------------------- ----------------------- . - k -` ----- ----- --------------- ----------------- = ------------------•---------------------•-----------------••-----------:-__, I hereby certify that I have prepared this application and that the work will be done iri accordance with San Joaquin County ordinances, State laws, an4r1les and regulations of the San Joaquin Local Health District. .1----l._ . -------------------------- -(Own -agar Contractor) (Signed)---------------- --- - -- --- -------- -- --------------� --------- -------- -------- -----=-------- ----- ------------- --- --- P �' 1~ (Title) (Plot plan, showing size of lot, location of system n.relation•tn`wells, buildings, etc., can be laced on reverse side).- - 3 'FOR DEPARTMENT USE ONLY �/ /� y--------------- APPLICATION ACCEPTED•BY ----- C ...�- - DATE ( -- , .- = DATE------------ ------ -:-------------- REVIEWED BY---------------#---------------------------- •-------- -- --------- --------------------- BUILDING PERMIT ISSUED----------------------- -- -----------------•------- DATE Alterations and/or recommendations:--.-"_ ---------- - --�� - ---- --------- 4 6_eed� -------- W4( - ----------------- -- -- --- d --- ----- -- �---- ------ --------------- -------- - - - -------- --------- --- 3 k - . '- __e --------------------------- Date--------- � G ----------------- FINAL INSPECTION BY:......... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVI56G 8-S9 3M 3-'63 r.p.CO.