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FOR PFFICE USE: -----`---- ------ --------LD_-' � = , _�_ - APPLICATION FOR SANITATION PERMIT Permit No. .1.7..�� .t --- ---------- ---------------- - ------ (Complete in Duplicate) Date Issued -- F - - - ............... � 11__ __________...__._._..__. 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........i�;k: -----------------------------S-7?v- --------------------------- Owner's Name------- C.nn- .....Ca's-T-R--------------------------------------- ------ ---------------------------------------"PhoneC,r._Sr:-_teZi!::__ -�%�Address.................. -•6-+7........... ......... ar '---------------------------SAN------- .......................................... Contractor's Name-------P?r I°'..!-%'-14......I.r ---------------------------•-------------------•-•---------- ..... Phone._4(;-..^-._1-i0-7- Installation will serve: Residence ❑ Apartment House ( Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _3___- Number of bedrooms 6--_ Number of baths __4_.. Lot size •____ ----------------------------- Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table -�0. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R Hardpan ❑ Previous Application-Made: (If yes,date__________________) No i� New Construction: Yes ❑ No N FHA/VA. Yes ❑ No N TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation.-._--______--___..Material___----_-.._-_-___-__-.___-____------.---_-_-_--. ❑ No. of compartments-------------------------Size---•---------------------------Liquid depth--------------------------Capacity_-------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line................. ❑ �? Number of lines-----------------------------------Length of,each line_-_____-_.---___-__-_____-_-_.Width of trench---------------------------:___----_ Type of filter material_________________________Depth of filter material-----------------------Total length___-____-_______-:---__________--_____---_ Seepage Pit: Distance to nearest well--- --- ---------Distance from foundation-----1_0...........Distance to nearest lot line----zip....... 0 �� ' Number of pits_____._)__________lining materia l_.>�_�__I�oc..1�_.Size: Diameter._.__-D.___._____Depth----------- �_____________ �✓ Cesspoo : Distance from nearest well-----------------_Distance from foundation_.------------------Lining material-----._-----____---------.-_____--.-- -J ❑ Size: Diameter-------------------------- -----------Depth--------------------•-------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----.-------------------_._- _---_---_. V% ❑ Distance to nearest lot line---------------------------------- -----------------------•----------------------- -------- -�� Remodeling and/or repairing (describe):--------1-_1 -A-----�.------'�--�L--1_S.�LIJ_G----------+5-!r?S-TE�M--=---------------------------------------------- J/ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------- ------ a., ----------------------------------------------------------------------- -----------•----------------------•------------------------------------------------------------------------------------------------------------------ p ---------------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------------------'-n-Y'.�._l_.�.- ------------ N__C--_I_____________ -.-. caner and/or Contractor - By:------------- LZ'` -- (Title) (Plot plan, showing size of lot, locatiog of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- - ---------------------------------------- ----- DATE. �- fL REVIEWEDBY---------------------_- ------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED...........---------------------- ------ DATE------------------------------------------------------------ Alterations and/or reco mendations: ---- --------------------------------------------------•------------------------------------------------ / --------- g �° ------------------------etl�°---------------------------------- - ----------------------------------------------- --------------------------------- ----------------------------- ------------------------------------------------------------------------------------------------------ ------------------------ ------------------------------------------------ --- -------------------------------- ----------------_..------------------------------------------------------------------- --------------------------------------- ------ ---- ------------ ---------------------------------------------•----------------------------------------------/--------------------- -------------------------------- ------ ,0!57 FINAL INSPECTION BY:--------- T�`<°'----------------- ----------------- Date----------- / SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CD.