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FOR OFFICE USE: --------------------- f= 4t j 62_ . '� tS APPLICATION FOR SANITATION PERMIT . Permit No. ..... 1._��-- .� ---- ------- ------------ ------ -------------------------- (Complete in Duplicate) Date Issued --- This -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. 1--) X" ADDRESS AND LOCAT N---- ----- � + - V•---------------- --------------------------------------- JOBr ---------r ------_ Owner's Name-------------- AddreAddress-------------- ss.------••----- ------.----•-.- 3 r ----- -- -------- ----------•----------------•---•---•------- -------... Contractor's Name-----------------------------•F--- = -------------------- - ---•-•-•------ Phone----------------------------------- Installation will serve: Residence [t--Apartment House C] Commercial E] Trailer Court [IMotel El Other [I Number of living units: __T._ Number of bedrooms-Z,,Number of baths 4__-- Lot size _y~��---- r-------•-------••--------•-- Water Supply: Public system mmuriity system ❑ Private ❑ Depth to Water Table _ --- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe ardpan ❑ Previous Application Made: (if yes,date--------------------) No ew Construction: Yes ❑ No ©-FfHA/VA: Yes ❑ No [-- 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------- -_Distance from foundation--/. -___.-__.Material-_,_ __ i. --------------- No. of compartments_._.?----------------Size--- X -G.---------Liquid depth---,�i...............Capacity....��.-----• Disposal Field: Distance from nearest well......_-=-------Distance from foundation---IQ...__.........Distance to nearest lot line---47:______- ❑ 'r � Width of trench_.c. -i-----: Number of lines--------- _ _I------------Length of each line- ___._---- -- - v Type of filter matedal.��------------------Depth of filter material-----2_ZI------------_Total length--------f______----------------------•-- I Seepage t: Distance to nearest well______________________Dista e f ndation__f __.____._..Distance to nearest lot line__ _______.. Number of pits----------------------Lining materi __ ---.Size: Diameter__ _4,-----Depth__.�a __...---------- - . -__ rem foundation___________________Lining material_________ _�L___-.___.______ ___. Cesspool: Distance from nearest well____-_________-Distance ❑ Size: Diameter--------------------------------------Depth---- 1----•-----------------------------------Liquid Capacity------••------------._---•-•gals- Privy: Distance from nearest well-----------:'!---------------I----------------Distance from nearest building------------------------------------------ 0 __._..___ ___________________------.❑ Distance to nearest lot line_----------------------------->------- -- ------------------- -----•----------...----------•---------------------------------------- .s , Remodeling and/or repairing (describe):---------------ln '! :4_- :_rf' '� �`� _ _� { ----•°--------•------••---•----- ---------- I -----------)e------1_ c r�_rl ._�� _ (. i 4._e � �`' `terve -----------LA------HI- 1------------------ ----------- - -------------------- ---------- • - ;----------------- - --------- �` x : ----- :x1 I hereby certify that I have pre lred this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. X1-6-6 (Signed)----------------------------- ----- C2--- -------- -----[Owner and/or Contractor) B ............-------------------- (Title)) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY [ ` 4~ �-- DATE . . - = • REVIEWED BY-----------•------------ -�.1 Y------------------ - ---------=------------------------------------•--------••-----------• DATE---------------------------------------------------- BUILDINGPERMIT ISSUED-�----------------------------------- ------------------------------ -----• DATEti--._------ .---..------------------- -----------------•------ Alterations and/or recommendations:....l-- t `- ' �' �- ---•-- `�•----------_---- � - ----ti------f"'„1.. ............-------- L .r .. t.*---------------_-- -------------- ��...- ``•:--- - ---- _ __.s-_-_._ ___-__a___________________ ------ z-.-- V oKV ------ �.h ------- ---------------- n /' -.--- ., ea----;_lA------ gam f,*----- wR�. = 1 ©�S%l"IF 9 __moo `e�'�_-. Sv� ®P�l�epi G—_ C. /ICd� FINAL INSPECTION BY:__. �-"------- Date__.- I�_ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 611.9„EV111[9 0.59 F.P.00. $M 6-60