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FOR OFFICE USE: '_l,�- .,_ APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ___._..._._- 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. JOB ADDRESS AND LOCATION-------------±----�--�-:��---------�. £. - -c ------ t ----------------------- - ------Phone----------------------------------- Owner ------------- ------- Owners Name- •-------------•--"--------- ./f--•-•--- 1 . -_------------------------ ----- ---------- -Phone Address----------•------------------------------------•-••-_•- r-1��' �lJ f = -----••---- 1 � -------=------- Phone------------------------- Contractor's Name---------1 /� ... �' -�.... Installation will serve: Residence �artment House ❑ Commercial ❑ Trailer Court ❑ . Motel ❑ Other ❑ r Number of living units: J---" Number of bedrooms 2_. Dumber of baths _.Z_ Lot size ------_-/,5�___rte"-/sem------------------------- Wafer Supply: Public system ❑ Community system rivate ❑ Depfh to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam E] Clay Loam ❑ Clay E] Adobe @--Hardpan 11Previous Application Made: (If yes,date--------------------] No New Construction: Yes No ❑ FHA/VA: Yes [4--tqo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Disstance.from nearest well.- -r....Distance from foundation._/C_ _ _-.---Material... . ""."r G"_ -__"------".. i Size. - p---liquid c!'epth P Y No. of compartments.. -_--- �_ j. __Ca acit r.fi Disposal F d: Distance from nearestwell:'._.__..--Distance-from-foundat'ion-_.,/�O�'._.-.Dis'tance--to nearest lot line------ Number of lines---------- Length of each line....7.�� Sr..Width of trench..---------------_--___..._ Type of filter material ------Depth of filter -----------Total' length,_ ______________________________�, /O! t �1 Seepage Distance to nearest well--------- foundation____- ..______-....Distance to nearest lot line.'.........."""_ Number of pits-----_.__---Lining material-.I UCA--'---:-Size: Diameter.�j__j!----------Dept Ca_�-_.�r2J y Cesspool: Distance from nearest well.................Distance from"foundation__........"=-:.Linin material-..........._-._-_------...._........ ❑ Size: '-------------- --------------------------------------- E Liqui - - Capacity -------------------------gals. � Diameter____....ar.est.' Privy: Distance from nearest well'•':.-------.__- -----------------Distance-from nearest uildin ------ -g----------------------------------------- 0 ---- -------------- - Distance to nearest lot line--- ------------------•--'-------=-------------=-------------- --------------------------------------------- O f Remodeling and/or repairing (describe):------ -- ' t .................. ........ -------------------------------------------.---------------------- _---------------------_-------------------------------------- I hereby certify that I have prepared this application and Fthaf the work will be done in acco�,dance with San Joaquin County ordinances, Sfate laws' ddrules and lations of the San Joaquin Local Health District. 1 ' 41Z G}-�J ---- -----------------------------------------I-- --.-- -(Ow and/or,: ontractor]Si nedner C( g ) - { � --- - `--- Title BY:------- ---------- f (Title)_ lc-�-,pati'....... ' (Plot plan, showing size of lot o ation of system in relation to wells, buildings, etc., can be laced`on'reverse side), s s. FOR DEPARTMEN--USE ONLY t .w i I � - J DATA 3 / - APPLICATION ACCEPTED BY...-.---- . �`�r�-------------------•-----• �f _, ! REVIEWED BY"------------4------------------ ----------------------- ----------'-------------------------------- •-------------=-------- DATE------------------------------------------------------------- BUILDING ---------- ----------------------------------- ---- ! BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------- - DATE-----------------..�.: i Alterations and/or recommendationsc.-_- ---- .:��.,�i�'.-_��4rLr�r ..._ .11 _ t .--'-- -- --� ----------------------- - ----------------,---------"---- --------------- -----.-----•--- ---- G - ' -.` -------------------------------------- -------- r .y. --------- -------- -ti �' r -------- ----------- ----------- I [� ee 'L ------------------ Date--------------------- ---- --- FINAL INSPECTION BY:-----'----1_z-- .. .. ----- ---------------------'--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. 300 West Oak-Street �� anI24 Sycamore Street 205 West 9th Street Stockton,California Lo' J,6a1ifornia� J' Mteca,California Tracy,California E5 9 REVISED 8-59 3M 3-'63 F.P-CC, �T