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FOR OFFICE USE: F ( ,_ 9-5.0 _.._._.;.-- ----- -------------------------------------- APPLICATION FOR SANITATION PERMIT �� Permit No. -----------------------=------------------------ ------ (Complete in Duplicate] 46` Date Issued --------- - ---- - --------------------------------- --- This Permit Expires 1 Year From Date Issued �V 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 LOCATION44.o,.J_Y�_.'I ---- ---------------- Owner's N __ j s .Pl. --_ ----------------- --------- --------------- ----------------- Phone ------------------------- Address-_C2� - s;(J J..` � "u- X4� t�C' -------------•-----------•---------1_----------•-------•---- 1. Contractor s Name-------��r ,.e..t-e ---•--1 ------- ----------- Phone---------------•---- ------.----�- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E 'Number of living units. --,/--- Number of bedrooms �_. Number of baths _�_-_ Lot site _ c�____ ¢—_________________________ i Water Supply: Public system ❑ Community system El ?Private [Depth to Water Table . _-___ ft. r -_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay+❑ Adobe ❑ Hardpan M__"'r Previous Application Made: {lfyes,date____.r-_. .1----} No;❑S,rNew Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPF OF INSTALLATION-AND SPECIFICATIONS: - �' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi�ank: Distance from nearest well_____-6Ct-----Distance from foundation-----/,4?_.......Material-___ -_---___- LI _Size __ _Ca acit _ _ No. of compartments- -�.-------- -- Size-V41�-X--£•- -----Liquid depth------�--- -;� � A Y--•�e�-C3--�' - Disposal Field: Distance from nearest well.._© ___Distance from foundation____--/>�____._.Distance to nearest lot line_:_____._____ } �t Number of lines___._________I___ Length of each line--------/CLQ__°_____-._.Width of tre ch°_ .,?_� _.____.__.. ------- -Type of filter material----_______ _ ________Depth of filter material_._____18_F-_____Total„,Iength-Y.____- 0�-------------------- I _ _ _ Seep ge Pit: Distance to nearest well--,__f 0-- ---Distance from foundation______0_ -------D�is!tance to nearest lot line_____.-_._-- !� Number of pits_;_----___________Lining material_____-1--_ .Size: DiSmeter-------0....... Cesspool: Distance from nearest weil--------------___Distance from foundation--------__.__''-.Lin ing-material-_. A1 G❑, Size: DiameterVN Dept ----- Li Liquid Capacify-------- i g 0 Privy: Distance from nearest well ___________________________________________'---Distance from nearest building----------_________._____..______._..___-- ❑ Distance to nearest lot line---------------------- ------ ------------ ° --------------------------------}------------ -------------- Remodeling and/or repairing (describe):____\----------------- ---------.--------.------------ __ j -----------------------------••------------------•---------------------------•---------------------------•---•-------------------- ------------------------------------------�------------------------ ----- -----------------------------------------------------------------•--------------------------------------------------------------------------------------------•----------------------------------°-------------------------- ----------------------------------_.---------------------------------•----------------------------------------------------------------------•- ---------------------------------------------------------------------------- 1-hereby cerfify.that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State las, and rules and regulatio of the San Joaquin Local Health District. (Signed)--------------------------- -------- -- ---- --------- ------------------ --------------------------------------------------------- -----�'6waeF..�nd/or Contractor] By: =-'_ -� -----------------------------------(Title]---------- -------- -------------- - ------------ (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY %� -------- DATE--- _REVIEWED BY---------------------------------------------------------------- ------------------- -------------------------------------- DATE BUILDING PERMIT ISSUED------ -------------------=------------------------------------------------------------------------ DATE_ Alterationsand/or recommendations------------ -- -------r-----------------------------------------------------------------------------------------------------------------------••------------- ------------------------------------------------------------- ------- ----------------------------------------------------------------------------------------------••-•--------•---------------••----•-----•--------------- ----------------•---•----- ---------------------------------------------------------------------------------------------------------•--- r ____________________________________________________________________________________________________________________________________________________________________________________________________________________ __________________________________________________________________________________________________________________________.._______._________._..______._.__-___.-__.._.____._.________._____..._______--_...______-._..__.._ FINAL INSPECTION BY:. - - �� ------------------ Date--- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CO.