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FOR OFFICE USE: ��_--- Permit No. 7/I I ------- -------- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued ---04 ------------------ --- ---- ---------_- - _- -_Ir- This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct ad instal;the,wo�rk,4 erein described. This application is made in compliance with County Ordinance No. 549. ? ,� i `- --- --------------------- JOB ADDRESS AND LOCATION s� ---- - ---- ----------- ------- ---------------------- Phone-------------•---------•------------ Address------- j �'' - �- --•---------------------•- -•------------------ --- ---- r ... Phone-----------------------------------'3y Contractor's Name_S.�r- •• -----: -•-�"- ��--�-- ❑ Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other � Number of living units: ---I---- Number of bedrooms-3--- Number of baths f---- Lot sizeCr';' ------- ------------------------------ D Water Supply: Public system [I Community Community system ❑ e pth to Water Table 4n ft- Adobe�,,�,��ardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ NoClay ❑I HA/VA: Yes n No / ❑ Previous Application Made: (if yes,date--------------------I No 04, New Construction: Yes ❑ 4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.), Septic ank: Distance from nearest wel J 7_----- Distance from foundation___-,P-____--____.Material__ �apci Sept' " Size__. =�- Liquid depth-----� dd NE!ro. of compartments------------- --- �---- � - Disposal field: Distance from nearest well-In?------Distance from foundation./�?-------------Distance to nearest lot I��e_.____._._____..- Len Length of each 4ine___.7'r7_ ______________Width of trench_--z--fy ------------------- 1 (� Number of cines-------- ,�--,�-.--------- g Type of filter material_--I��t�. -------Depth of filler materiaL �_______Total length ------------- Seepage it: Distance to nearest well. ---_/ -r__------Distance from foundation__10-. .__.--.Distance to nearest lot lined!X___--±-_ .Size: Diameter__. 3------------- W Depth . ktj Number of pits____-.-----------Lining material__p'Gx---- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material---.-------------------------------__ F-1 ---------Depth----------------------------------------------------Liquid Capacity----------------------------gals. ,71 Size: Diameter--------------------------- - Distance from nearest building-------------------------------=---------- Privy: Distance from nearest well_________________________ In In ❑ Distance to nearest lot line---------------------------------------------------------- •- ---- ----•----•----- ----------------------------- Remodeling and/or repairing (describe):----------- ---------------------------------•------•----------- -----------------------------------•-----------•--------------------------•---------- 3, ---------------------- ------------------------------------------------------------------------ �_ -----------------------•----------•----•----------------------- ----- ----------- ----- - - - ------ - - -----------I here- -b-y--certify-- that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St*wsd rules and regulations of the San Joaqu'ft` ocal Health District. ' (Owner-a1rd/or Contractorl (Signe --------- ------ - - ----._Title--------------- - ------ -- -------- .. .----------------- --------------------------- By: .-. - -- -- --- By: (Plot plan, showing size of lot, location of Sys m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- r ----- ------------------- ------------------- --- DATE------- `,3f�.-.G. ---------------------- ' --------- ---- DATE------------------------------------------------------------ REVIEWED BY - DATE------------------------ , ------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------- ---------- and/or recomm ndafions:_ - - --------------------------------------------------•-- -------------•------------- -�� -.- •----•--- - ----------------------- ---------------------------------------- C 7�LOQ--------------- Date -�-�--�° µ -------------------- ---- FINAL INSPECTION BY----------------i----------------------- *44 ---- ------ *44 SAN JOAQK4 LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 91h Street 1601 E.Ha:ellen Ave. California Stockton,California Lodi,California Manteca,California Tracy, ` ES 9 REVISED B-59 3M 3-'63 F.P.DD. -