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FOR FFICE USE: -- -/---. -- ---- '�--------------- �_ APPLICATION FOR SANITATION PERMIT Permit No. .../..7.t3./_40' (Complete in Duplicate) _ This Permit Expires 1 Year From Date Issued 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. �Sr! GGi C. q.N, ST`_ JOB IDDRESS AND j� �f LO ATION.. L_t�-.s?" , Owners Name------------ --- - ��------ ,tom' -'- -Q_•�_c_a---------------/.yam/_�_ ��?�__��11��-t`)/�/�----•--- Phone/-�_CX7_�,�,�'1 Address---------- Contractor's Name---- - `4 r 4 - ✓ -. =-_----------------------- Phon - - Installation will serve: Residence ❑ }Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other W A'//;'"C Number of living units: -------- Number of bedrooms _______ Number of baths .. __ Lot size ______ 4`. -- Water Supply: Public system ❑ Community system ❑ Private)N Depth to Water Table APt ft. .� Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam ❑ Clay Loam ❑ Clay [] AclobeK 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.) - I Sep Tank: D;stance from nearest well_ ---- .....Distance Dista� foundation ___ 0-_- --___Mater ald*rv-ap � 19 Noof compartments----------'� ---------Size _ , _ ._.-Liquid de th___ - Capacity - Disposal _ Field: Distance from nearest welIAPA_'___Distance from foundation..-LP-'_.____.Distance to nearest lot line____:'____ -- rn Number of lines-------;— --------------------Length of each3line__ -.------Width of french--------0..,V__.`___---------- Type of filter material_�`_4ePe:-___Depth of filter material____-_'T'- -----Total length--------------_......fts=�?_�_______ 4 Seepage Pit: - Distance to nearest well__`__0..__._____ u Distance from fondafion___../0!._.-..Distance to nearest lot line_____ _0__.__ g -Depth - _. l �} Number of Its------,il;.-__:.__.___Linin matenal_�.-___ --'- -_.Size: Diameter_.__= Cesspool- Distance from nearest well-----------------Distance..from foundation_ ----------{-----Lining material----_-________________._-_________. ❑ P -----------t -----------------------Liquid Capacity----------------------------gals. Priv Distance from trnearest well--------------------- _ ______________�e_ h.__--___._._._-:__Distance from nearest building - Distance to nearest lot line__--------------- ________________________ ¢..._____i_ --------------- Remo clelin or e atria describe _,. 9 �� / p g�� ) ✓ xG'-� � __ mac. -�P.s�� ..—_ -� �r �t v - S`'� ___-� -sr r--.tt c - !11�•_• --------------------------------------- � - I hereby certify that I have prepared-fhis,application-and-fhat the work will be done in accordance with San Joaquin County ordinances,;Stafe,laws,.,and,rules,and. regulations •of. the-San Joaquin Local Health District. (Signed) t-€ &_ } ; 1 , (Owner and/or Cont rac+or By;. . -----�Y- r-- -- -------------- ----------- - - -----------Title) - ------------ ------------------------- (Plot ----- ----(Plot ) plan, showing size of lot, location of.system n relafion-to-wells-buildings, etc.,.can be placed on reverse side). FO EPAR MENT USE ONLY APPLICATION ACCEPTED `_ - DATE REVIEWEDBY ---------------------- ------- --------------------------------------= -------------------------------------- DATE---------------- BUILDING PERMIT ISSUED---------_------ Sl1 , t- 4 ,' - l Df4TE ' -- -- --------- - - Alterations and/or recommendations-------------------------- ------- ------- -- ---- ------------.- --------------- -------•-•-----•----------•--•-----------------------------------=-- ---------------------------------------------------------------- --------------------------------•----------------------------••------------- ------ ---------------------- ------------------- -- ------- = -t-- -- ---------------------------------------- FfNAL INSPECTION BY.. Date 2 -- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-59 3M 3•'63 F.P.CD.