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FOR OFFICE USE: -------------------=---------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...Ar/9Y_ ---------------------------------- ---------------------------------------------------------- (Complete in Duplicate) , .� � __.__.___________________________ ------- ___ This Permit Ex ices DataIssued 1 Year From Date Issued I I 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 AN LOCATION_ - '_'______/'�- r.. _ ___1, y� _._./ -,__ ii_ _______________________ Owner's Name-._._ _ '------------------------------------------------------------------ -------- Phone--------------------•--------------- Address. / --------- ---- - --' --------------- -- Contractor's Name.__�G �rx ,�f : q.._ Amw— Fe. --------------------� a--.<�PhalS eft'.---------- Installation will serve: Residence C Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑0 Other ❑ 11I Number of living units: ________ Number of bedrooms �__ Number of baths _�.___ Lot size ____________________________________________________________ Water Supply: Public system ❑ Community system ❑ Private it Depth to Water Table1_Q. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam.] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {If yes,date--------------------) Not New Construction: Yes, No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF- INSTALLATION-AND SPECIFICATIONS: I _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Septic Tank: Distance from nearest well-._.__Distance jrom foundation---[ _ ._.__._ Material__ ---------------- i;. No. of compartments--- -------------------Size-3-.f._!t,r-------------Liquid depth----- ---------------- apacity-. -,------ Disposal Field: Distance from nearest well..Xa......._.Distance from foundation----IR---------Distance to nearest lot iine._5 __._._.____. Number of lines____'__ ________ _ _-___�_ ___Length of each line_._..�A_-__--`-----.-..Width of trench. __ _ �'_._ Type of filter materia _ De th of filter materlal_____et_ __________Total len fih. �s0------------------------------ Y p - -- 8�'4`'= p 9 Seepage Pit: Distance to nearest we I.- --------------Distance`from foundation___-----__-_-_---.Distance to nearest lot line----------------- G ❑ Number of pits--------""`".`"'_`_'Lining material------------------------Size: Diameter------------------.----Depth--------------------------------- 0 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materialll:------------------------------------ _,.^ 7 , ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------- ---gals. Privy: Distance from nearest well----------------------------------------------- Distance from nearest buildin- g 1----------------------------------- � ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------- --------------------------------- Remodeling and/or repairing (describe):------------------------------------- ----- ` -' II' ---------------------------------------------------------------------------•- •-------------------------------•----------------- ------ ---------------------------------- --.;� I � . I hereby certify that I have prepared this application and that the work will be done in accordance withl'San Joaquin County ordinances, ate laws, rules and regulations of the San Joaquin Local lth District. 7 (Signed) _ N 4 ( Ir and/or Contractor) By:. - -- - --(Title)-------- ---------------------------- - i --- �---------� . (Plot plan, showing size of lot, location"of system in relation to wells, buildings, etc., can be placed on never'd side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ --------------------------------------------- DATE--J/- _7-Z!�-�/-------------------------- REVIEWEDBY------------------------- --------------- --------------------------- ------------------------------------------------------- DATE----------------------Ri--------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-----------------------df--------------------------------- -- Alterations and/or recommendations---------------- ------ ----------------------- -----------------------------------------------•------------------------ �p ------------------------------ III. ---------------------- ---•-------------------------------•- ------------------------------------------------•------- -1 --------- ----------------------------------------------------------------------- - - 1i' II: FINAL INSPECTION BY:. --------- ---- --------- Date--//---.2— -4 - --------1----------i- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 2051 West 9th Street Stockton,California Lodi,California Manteca,California 7rI1 cy,California ES 9 REVISED B-59 3M 3-163 F.P.CD. -