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FOR OPFICE USE; ----------- - - ----------------------------------- / --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ....�._f? ------------------------------------------------------ (Complete in Duplicate) A 3 : Date Issued .___�........__.�-� __--------------------------------------------------- ---- This Permit Expires 'i Year From Date Issued I Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in complianceth County Ordinance No. 549. "1"'�-xS'a t.� �v - . �E. i �-�c � f ,� r tom.• •?�w JOB SSI OCATIO ----- /- - ---- ------ -- '-`' - • ------ Owner's Name..y,.�taat�� . .. •-----� ----- -- Phone-------------------- - J r. _ Address,. "� �� p --------------------------------- --•-----.. -------------------- Contractor's Name---- 1dYid i _ {' --i ce----- ••---_-- Phone.. Installation will serve: Residence ❑ _Apartment House -E].- Commercial •❑"Trailer Court ❑ Motel .❑ -Other EIC Number of. living L uniti: ________ Number of bedrooms -------- Number of baths ........ Lot size__________________________________________________----`---- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _� ft. VX1rT �I�7 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes, date ----------- _------- _I No -R New Construction: Yes es No ❑ FHA/VA: Yes ❑ No>Q TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_A'02__t—Distance.from .f fo�unda�tion____..._.-- No.-.of_compartments_.___.__�- ____._._-Size__.Liquid dept.h_-_M___-ate:'ri_a_l._.__1_x _y__L_-C-apacity.L�j50. 01?!14 Disposal Field: Distance .from nearest well.zv------ Distance from foundation_._..at`':Distencer,to nearest lot line.--. ............. d a e- i - - 4 f 10` Number of �lines______.�-------- ----------- Length'. of Teach line----!_k_Ei_-------------- of trench.-- --;----.••-_-•-.-__-... ` Type of filt r mate�ial__-F_0_Gj�----- Depth of filter material___ �_17_��________.Total length____,2_X7.0.:'___________------------- Seepage Pit: � Distance to nearest well # _____________________Distance from foundation ---- .-------------- .pistance to nearest lot line _______._______. ❑ Number of 'pits ----------------------- Lining material --I..Size: Diameter---------------------- Depth --------------------------------- Cesspool: Distance from nearest IWell_________________Distance from foundation -------------------- Lining material ------------------------ .-------- ._._ m El Size: Dia;me'i er 1 f De th- `----------------------- ---------.-Liquid Capacity gals. Privy: • - Distance yfrom nearest w*II____ ____________ t---- __,f _..... Distance from nearest building_.__,- �_________:__________________-._-. ❑ Distance to nearest lot line t - _ "-i= = "= ,- t# Remodeling and Io r repairing (describe)__.____- ± t ` ji 1 1 i no 1 i ________________________________________________________________________________________________________•_------_-_______+(______________-_______________.___,,-_____.________.__________.:_.._:______-.._--_ - _ __________________________________________________________________________________________________________________________________t_______-_-________________-_____________________________-_-_._-_..______-___.________..__._ 4 1 hereby certify that -1 have prepared this application and that'+be„work-will be,done.in-accordance with San Joaquin County ordinances, State laws, and -rules -and reguletions-of-the San~Joaquin Local Health District. — .t (Signed )= -- `: _-_ -•. -•--- =:`r - -- ----------------- (Owner and/or Contractor) *�' �. , Title 4 (Plot Plan,, showing, size, of, lot, location of system in relation to wells, - building s,`etc.^can. be, placed on.reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --------------------- REViEWED BY ------------------------------------------- ----------------- --------------------------------------------------------------- DATE ----------------------------------------------- ------------ BUILDINGPERMIT ISSUED ------------------------------------------------------------- ---------------•----------• -....1• DATE -------•-------------•-•----------- ---------------- ------- Alterations and/or recommendations:-_lZ- -- - -- z----------------`J-s2. �1�,------,r¢.-.lR-------5------ -- ---- ---------------------------------- ------ _-�_----- FINALINSPECTION BY----------------------------------------------•---------------- Date -------- --------------- .---------------_. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street T24 Sycamore Street 205 West 9th Street Stockton, California Lodi, California E5-9 REVISED 6.59 r.r.co. 2M 6-60 Manteca, California Tracy, California