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FOR OFFICE USE: -NO J -------------------------------- --- `} Permit No. ./.:� -f- .r APPLICATION FOR SANITATION PERMIT ------- -- (Complete in Duplicate) t Date issued ---�//-----61 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. rt � C ......�. ....�3---ls ..., - a . . _JOB ADDRESS AN LOCATION OwnersName--------- t ------------------------•------------------------ - ...................--- ` --- ......... ..... yoAddress. --•/ --- --I . Contractor's Nam � ---- � Installation will serve: Residence A artment House [I Commercial ❑ Trailer Court [3otel ❑ O er ❑ 0 -••-•-------•/s -----•....... Number of living units: ...1-_.. Number of bedrooms ___ Number of baths ---�..__ Lot size ---------------------- - -• Water Supply: Pubiic.system O Community.system ❑ Private❑-'Depth to Water Table ,rj t. Character of.soil to a depth of 3 feet: Sand ❑ Gravel [I Sandy Loam [3 Clay Loam [I Clay C3 Adobe[ HJ' an (3 Previous Application Made: (If yes,dote--------------------) No P-`New Construction: Yes 2,-No ❑ FHA/VA: Yes ❑ No 2-� 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------------------------------------------------- Capacity •. No. of compartments----- --------------------Size--------------------------•----Liquid depth--------------------------Ca P tY-•-------•-••---•--- isposal Fi Distance from nearest well-----------------Distance from foundation.....................Distance to nearest lot line................. e Number oflines---------------------------------.-Length of each line-----------------------------..Width of trench.-----•------•---------------------. Type of filter material_----------------------Depth of filter material----------.------------Total length--..--_---------------•-•------�J- Seepage 4 Distance to nearest well ----------------Distance from foundation---.-----__-__....Dista�ce to nearest line_ ----- � 4 Number of pits ---material._.--.Size: Diameter-- ..---------_Dept ... Cesspool: Distance from nearest well---------------•.Distance from foundation---------------.---.Lining material.._____.__--....---....._-.-gal_. 1 ❑ ----Depth-----------------------------------------------------Liquid Capacity.. gals. Size: Diameter.__...-_•------------- -- Privy: Distance from nearest.well----------------------------------------------- -Distance from nearest building------------------------------------------- 0 -------------------------------------------- -------------•-----•-----•-•-----�----------"---------•---•--------------------------- `. Distance to nearest lot line------------------------__-_--_---_______--______._ Re odeling and/or repaying (desGribe): � `r . = -- ....... --•---- -------------------------------------------- V--- --.._......--•--••----------------------------------------------•---------------------------- f •--------------------- - ----- ----------------------•------•--------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared 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. (signed} �� ----- '`"�'---•----------•--- ------------ ---(Owner and/or Contractor) 1. By:.. ----•---= ------------ tTiele) ''t"'�•'- (Plot plan, showing sire. ofd ot, cation of system in relation to wells, buildings, etc., can b placed on reverse si e]. f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B ------___ , .^--- -------------F -- .. . .... ------- DATE----------_-/ --- �_ _L. REVIEWEDBY------------ .................. ------------------------------------------------------ ---- DATE...-....--------...--.--------------------------...-------- BUILDING PERMIT ISSUED.__ ---- ------------------------------------------- ------- ,QATE I Alterations and/or recommendations - zZl- _ l 6 .. .. --•-•-------------------- - ---- �—�- -1 ) ------ ---------- - .- ...... ~` �- -� 1 2p>", } �-cwt--.JC/r? FINAL INSPECTION BY----------------------------- ------ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 9th Street t- Stockton,California Lodi,California Manteca,California Tracy,California E8 9 Ar VI5ED 9.59 2M 5-61 AILA5