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F ROFFICE USE: �r �-------- >� � APPLICATION FOR SANITATION PERMIT Permit No. �.. ..------- -- ----------------------------------------- (Complete in Duplicate) - -----------------------------=--------------------------' This Permit Ex ires 1 Year From Date Issued Date Issued _ _____/. Application is her 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. ,.J: JOB ADDRESS AND ---- LOCATION ��- �Y+v //�'�"`�� ti ' "` = � Owner's Name: P,------ ----0. ---•-- r - Phone Address-----)--1-3•4--- --- ---- - -_-----------------------------------------------------------••-•---•------------ TA Contractor's Name---- __,_3 --- ------------------------------- Phone----------------------------------- Installation will serve: Residence [`-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- Number of bedrooms -3--- Number of baths __a'_-__ Lot size ________r_ '_________________________ Water Supply: Public system;.[] Community system ❑ Private 'Depth to Water Table _ G' ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er—Hardpan ❑ Previous Application Made: (If yes,date___________________ ) No ® New Construction: Yes Z3-1No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perif public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_�b___f__Distance from foundation__j�___-____--Materia,---_ ''a--`_/_ _________- ----Size.__-------K6 -=-- -9---Li Liquid de th---�--------- Capacity`� No, of com artments____,� •� �__ q R __.____Ca acit �OQ J.___ ------------ - p r �+f Disposal Field: Distance from nearest welL -4-0__.r____Distance from foundatio+'�_Q________________Distance to nearest lot line_-_____ _______..J 0� Number of lines____��_____________________-______Length of each line----7�:-_'----------------Width of trench.!-_'�t''__- •---------------- W k ,_ -� s Type of filter materiai __�f_a�C--k-------Depth of filter mate " rial--/ ..............Total length_____IU. ------ __�__.._______ Seepage Pit: Distance to nearest well_�,D4>----------Distance from foundation---/0______.___.Distance to nearest lot line__!-�____-_- m Number of,pits-..�,`___________-Lining materia.__J r • �L-_'�.-----Size: biometer----`3--`�--,--------.Depth-- -� ---------------- � Cesspool: Distance from nearest well°________________Distance.from foundation-------------------.Lining material---------------------______-________ ❑ Size: Diameter----- `-----------------------------Depth------ ---------------------- ---------------Liquid Capacity----------------------------gals. Privy: Distance from-nearest.well------------------------------------------- Distance,from (nearest building______________----_______________-------. ❑ Distance to nearest lot line ' ---------------------t-r-------------=`� -----------------------------------------------------------------------•: - --- ---------------- Y Remodeling and/or repairing`(describe)------------=_____--_--_- -7 � t �� •e*t ---------------- ---------------------- ------ d = i, v y ___________ ere_ ___ __ _______________________________________________________ __ _____ ________________________________________________________________________________________________________ _____ ___ _ ______ __ ________ ______ ! hby certify that I hays prepared this application and that tile' work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. s r or Contractor -------- (Owv } k-560- . (Title)__ (Plot plan, showing size of lot, location of system in relation to wells,.buildings,.etc.,.can be placed on reverse side). #3} FOR DEPARTMENT USE ONLY _ l APPLICATION ACCEPTED BY----- ------- -- -- l ------------------------ `� �� DATE ----- REVIEWED BY---------------------------------- = ------------------ DATE------------------------------------------------------------ -- PERMITISSUED-------------- .` ------------------------------------------3------------------------ DATE------------------------------------------------------------- A. Alterations dlor recommendations------------------------------------------- --------------•-=---------•----------- --------------------------------------•------------- S-�f-L� -- ----------------------------------------------- f ------------- ---------------------- - a __ ------------------- �' � �', -ac-c' -_•- ' ------------------------- ------------------------------- -------------------------------- ----------------=------------------------------------ -------------------- ------------•------------ ------------------- ------ ------ i 'i �- Date---------`.'l-^��1` �} FIN ----------------------------------------------- AL INSPECTION BY:_ c' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasollon 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.CD.