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FOR OFFI E USE- f f /I APPLICATION FOR SANITATION PERMIT Permit No. ----------- -- ------ -------- .... ; _Vc- ,-+�- [Complete in Duplicate) Date Issued _...� ----------- --- -------- ------------------ This Permit Expires I Year From Date Issued 1-7-3I33_c�3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Tnis application is made in co Rliance with County Ordinance No. 549. If �r- �CQ 3 Z .9- . reu,W-7-F-e -!P e / Y. a JOB ADDRESS AND LOCATION = ��n----31-- ----- a-A-44c'e---------------------• ----------------_---------•-- Owner's Name------ 4 { ----141j- ----------------i------------------I---------------------------------------------------- Phone------------------------------------ Address-------------------------------- - -------•------- Contractor's Name------------ --/ ------- ----_____--- Phone----------------------------------- Installation will serve: Residence �e4partment House ❑ Commercial ❑ Trailer Court [I Motel [3 Other ❑++ Number of living units: �____ Number of bedrooms___ Number of baths _1-____ Lot size _________ ---••----------••- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table 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--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / ,/ Septic,! k: Distance from nearest well___ _Distance from foundation__/-Q----------MateriaLc--G�___.l r/-GCS_____________________ Ki No. of compartments------Z------------Si,e_ 5 X_y_'_(7___--_----Liquid depth------ Capacity....0�20_10-___-__. Disposal Field: Distance from nearest well___---__.Distance from foundation_./-O_-�__ __Distance to nearest lot line__' 1________ ❑� -----------_Length of each line_____-�-'i-------------- of trench---c_-Y.�'/------------------- Typeof lines___.__-�_.._____ � Type of filter material -j;�_!t"______Depth of filter material-----Y.._-_______Total length----IST__f_______________________ Seepage P' : Distance to nearest well---------- ance from foundation__/Q.j..-------Distance to nearest lot line-,5---_________ Number of pits-------'Z---------Lining material__7�-c-k_------Size: Diameter-----3.3-Y--_--Depth-_-. ,� ---•-------------- ti Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------.-_-____________. ❑ Size: Diameter--------------------------------------Depth--------------------- •-------- ------Liquid Capacity- -.1------------------------gals. Privy: Distance from nearest well--------_----------------------------------------Distance from nearest building___-_--___--.-____________--__-_____----_. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)---------------- ...... .......... -------------- ------------ -----•-------------•--------•-•-------------------•__ ---------•-----------------••-------- ------------------••---•------•-• -------•-------------------------••----- ---------------------- •- ------------------------------------------------------------ ------------•--------•- ---`------------------•-•------------------_------- ------•--------• ----------------------------------- --------- I hereby certify that I have prepiired this application and that the work will be done in accordance with San Joaquin County ordinances, State laws and rules a egulations of the San Joaquin Local Health District, (Signed) --- ------ o ----- -•--------•-----•-------- ---(Owner and/or Contractor) By:----------------------------- ------ ---•-- ---L� -- --- ------- ----- (Piot plan, showing size o t, locat' n of system in relation to wells, buil rn , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..--.d------- --------------------------- --------------- ---------------------------- DATE----. ------•----------------- REVIEWEDBY-----------------------------------------"-- --------------- ---------------------------------------------------- ----------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------•---------------------------------------------------.. DATE--------------•-----------------------------------------• -- Alterations and/or recommendations:-__ --.Z1_--__-&A--__--_-Ls+__-I]rt_ u1___=�___-- ----��1�•--0E-� g ----------------------------- -----------------•----------------------•-------;---- ---------------------------------•-- FINAL INSPECTION BY:-._._C__ ------- •------------------- Date_. `_(a---k-------- -------------------'------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr California Lodir California Manteca,California Tracyr California rG-9 RrVI860 19-59 F.P.00.9M 6.60