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FO O ICE USE: y� -------- - ---- - - �_�z3 APPLICATION—FOR—SANITATION PERMIT Permit No. ....... ........ --------- ------------------------------------- (Complete in;Duplic0e) 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. JOB ADDRESS 2ANLOCATI N_'b_j'._- #"" 1 o�-�T - __ ► Ph --------------- ---- Owner's Name ------- -------- ------------------- one__.... • - Address---- ---------------- ----------- -----------------•-----------------------------------------------------------------�---r------/------ --/----• Contractor's Name--------------------------- Phone:/..��.�.l � - -- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Tra�ilerBC urt ❑ Mote! ❑ Other ►[�$ . Number of living units: --- ---- Number of bedrooms -------- Number of baths_."{ t size -------/0-0 _ ------- Wate� Supply: Public system El Community system El Private Depth to Water Tabled_ ft. I. Character of soil to a depth of 3 feet: Sand ❑ Gravel [j Sandy Loam E] Clay Loam' Clay ❑ Adobe❑ Hardpan ❑ t Previous Application Made: (If yes,da#e....................) No F1New Construction: Yes No F] PHA/VA: Yes ❑ No E]:r ((< TYPE OF INSTALLATION AND SPECIFICATIONS: j. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest wel �Q_______Distance from founda�ian ___.____.Material_ ____�0__________________________ __ ------- _4 lI No. of compartments_-_____------------ Liquid depth__._---- ...........Capacity./_o�A_0_- Disposal Field: Distance from nearest well/6.Q--------Distance from foundation_/Q_________-Distance to nearest lot line_ _.._ U Number of lines--- -----_------------=-- )Length of each line__- ------------Width of -�---- Type of filter material$± --Depth of filter material__�S-_ ______Total length---------- _____;?__- _____-__. ,Seepage Pit: Distance to nearest wellJ40-Q-------_--Distance from f undation,-- -------------Distance to nearest lot line_,______,-. 3' Size:`Diameter__ �!.De th__--_ _ +�----------------- Number of pits------�--------------Lining material` -- *t. ��`��--- p � - „ Cesspool: Distance from nearest well______F_.'-. Distance from foundation.________----------Lining material__..__....___-_____..___.________. ❑. Size: Diameter-----------•----'`------------------ Depth------------ -------:------------ ---- -----Liquid Capacity -- ..gale. PrivDistance fromnearest w611-1------------ -___.__._'__ ________ _______Distance from nearest building__--- __________,__________- ' Y' - ( ' ❑ Distance to nearest lot line__t----=-------------------------------- - -=------ - ----------------------------------------------- -------- ------------ ��/ L Remodeling and/or repairing (describe):---_- --------- ------- I - .00p ---------- ------------------------ --------------------------------------------------------------- ------------------• 1--------------------------------------------------------- ------ ! t i ` I here rtify that I have prepared this application and that the work I rill be done in accordance with San Joaquin Count . „ ordinances, Sta a laws, and rules and regulations of the San Joaquin Local Health-District. ' a.. (Signed)------ ---------- --- -------•----- ---- -----4---- = � --- -------- wrier and/or Contractor) Ii - - �.�- (Title)---- -- '° Plot Ian, showing size of lot, location ofri stem in r a o ,wells, buildings, - Y'------------------ ----- -- ----- - �► ( P g y rigs, etc., can be placed on reverse side). FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- _—------------------ DATE------ f � 1�REVLEWED BY,--------------------------------------------- , -'�----- ------ :--- ---------------- - -- - ----- DATE-------------------------------- --------------------------- DATE----- .► BUILDING PERMIT ISSUED--------------------- ------ _ _-- --•--------------- Alterations and/or recommendations:______ /f1 - `=L;l --• --`- -- {2�`-r- - -- } • -�- ---- =-• �y `C ------------•------------ ---------------------------------------------- -=- ------- --------------- ----------•- -------'--------- ' ----------------------------------------------- -------------------- -----•-- -------- ---------------------------------_------- ----------- ' Date------------ --------------------- FINAL INSPECTION BY---- ----- S N JOAQUIN LOCAL HEALTH DISTRICT 4 1801 E.Hasellon Ave, 30 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 r.P.cc.