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FOR OFFICE USE: �� y . .4- PPLICAM FOR SANITATION PERMIT Permit No. .. ------ --------- _ f>-------------- (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-,---------------- -------------- '' ��lr'_--Y--e` w _ �3 I' -- ' Owner's Name.____ ___^______. - - --- ---------------��'-------------�- -----�--'-------------:,.-----------------;-------------------------------------------------- Ad -•--------------------- -- ---- ._. ----=--�------ Address �¢ 45r ...... -•------------ ------------------•--•••-----•---•-------------•--------------------- --- --•--------------------------•---•----- Contractor's Name._.�------ -- T --------------- Phone----------------------------------- Installation willtserrre ResidenceApartment House-❑f Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ Number of -� Number of baths _ Lot size __-- �-c _-a _ _ ------------------------•-------------- Water Supply: Public system ❑ Community system ❑ [Private UJ—fSepth to Water Table Ad ft. Character of soillo f depth of% feet: Sand Gravel Sand Loam Clay Loam Clay Adobe ardpan P ❑ ❑ Y ❑ y ❑ r ❑ L�Y� ❑ Previous Application Made: {1fyes,date_________________ ) No New Construction: Yes �o ❑ SHA/VA: Yes ❑ No, TYPE OF INSTALLATION'AND,SPECIFICATION S: """ `� (No septic tank or cesspool permitted if public`sewer is available within 200 feet.) i Septic Tank: Distance from nearest well-_17�____Distance from foundation____. - _ Material__ ____________________________ P 1A==7x _-3------Liquid depth__...------- Ca pacify, It �_�'"�` �2� No. of compartments - -. ��_lllrl � Disposal Field: Distance from nearest well.. 4 6)1.._Distance from foundation-_.-f-p------.Distance to nearest lot line_�r1•_-__-- [r]/ Number of lines-------------- _ "_ Length of each�lineE�(_`__�}��r'�7�.Width of trench.-----(.t��________________ _______Len � - Type of filter rnaterial__,,_02-- __Depth of filter material-----lAF-0------Total length__ --_-_- (. Seepag pit: Distance to nearest welLl_V________Distance from foundatio0_-4_ ..-jDisttaannccc to nearest lot line---- -V Number of pits--------.7�------Lining material----�.j.---c-A-.__'Size: Diameter" _.�-�_._-...---Depth___.��_;_________----._. V Cesspool: Distance from nearest -----Distance from foundation.--n't-------.Lining material------------------------------------- F1 Size: Diameter--------------------------------------Depth------------- ----------- Liquid- Capacity----------------------------gals. Privy: Distance from nearest well-------------------------- --------------------Distance from nearest building----.--.--.-__-.--------__-.-..__._____. ❑ Distance to nearest lot lire------------------------------------------------------------ - --------.--------------------- --------------------------- ---------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------- -------------------------------------------------------- -••-------------------------------------------------•-----------------------------------------------------------------•------- ------- - ------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------..._.,.-------------------------------------------------------------------- k' -- ----------- -------•-------------------------------------------------------•- --------------- •---------------------------------------- - -------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, s nd regulations of the San Joaquin Local Health District. + -,_ r_ Owner and/or Contractor (Signed)- ---- - -- . --- ----- �C� c-CZ --L�z-- r ----------------------------- ----- Tltlei f BY:----------------------/-------------------.-- -------- { 1 (Plot plan, showing size oflot, location of.system in relation to wells, buildings, etc.; can be placed on reverse side). ti � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ' -------------------------------- DATE �� -,--------------------------------------- REVIEWEDBY-------------------------------- ------------ -------------------- ----------------------------------------------------------- DATE------ - '----------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------- ----- DATE --------------------------------------- Alterations and/or recommendations:.--- -- :. __0------------ y- -- --- ---'`:� '-- -s -------------------------------------- ------------- ----. =-- ..-c�' r..,.c.�(r.-L.'-- e—t—= _..� er ------ --a�C .----------------- ---- ---- — ------ --- -�-- -`'=�=� P � ��""' � 5 ��----- -f--------- `�i`��.Gi,- Cf'�+r--t.P�- ?-�...��---- -- ----- •— �---------------------------` ��... - - - � -'� --- - `-��---�-- Gam- FINAL INSPECTION BY:. __--. -ff---- - ----------- �-- -------�� ��. ��r�.,::_� �, r --Z�`Tc T�-,�.� f)��f".` -C`t"z.-e� �-4� ?-c..o rt• 2/_j'_a�'-4..�:c:/- �i.,-c._�.j c��='.P pv �� ' SAN.JOAQUIN LOCAL HEALTH DISTRICT /- 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West Stir Street Stockton,California Lodi,Californiaj anteca,California / Tracy,California CS 9 REVISED B-59 3M 3•'63 F.P.C1I. �e��G r .�