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F OFFICE USE: J Permit No. ..1.'71�7�! q�Sl-_-------_��-'o.------_--. APPLICATION FOR SANITATION PERMIT ---_-_-_-_-.--------_ __ -- (Complete in Duplicate) 71 f u This Permit Expires 1 Year From Date Issued Date Issued ___ mss'�.. 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�L�O/CA�TyIyO�N ,/S--`0 __ "'`'' B------ .:.. ------- `-` Owner's Name------•4-- ------,1!� --------- --•--— -- ------------------------ -- --' -----� --- ------•------•--------•- Address---------`x--'--3--•3-9----> ...---•------- -------• --------•-----•-•---•----•------------------------•---------.....-----------------------------------------...-----------------------•----- Contractor's Name--- ----- -- -- ---------------------------------------------------------_---- ................. Phone----------------------------------- Installation will serve: Residence �partment House ❑ Commercial ET- Trailer Court ❑ Motel ❑ Other U!F� Number+of living units: ---I--- Number of bedrooms ..S_ Number of baths __3-- Lot size __,3_40J(---$2Z------------------------ Water Supply: Public system ❑ Community system ❑ Private Uq--15epth to Water Table __ Uft. 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 ER----New Construction: Yes No ❑ FHANA: Yes ❑ No ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan iL:� Distance from nearest well... --_Distance from foundation_/b_____________-M etial---��------e__----.-------.-._--_--____. No. of compartments----------------------Size____3_�S_�_..�_.Liquid depth__- __-.-__-------_-_--Capacity..(,t-_ -- I, Disposal Field: Distance from near st well./4p.-01..-__Distance from foundation../o----___-____Distance to nearest lot line.dv`_.—____".... [� Number of lines.____._._ _-__-_Length of each line_'---------- --------Width of trench._.:Z_1r._._---_--_-_____ i Type of filter material.....1_------ --�4-._Depth of filter material__/-_.`___.•---Total length------ _ _ l?.................... Seepage Distance to nearest well--- � ._._.-__Distance�cgm foundation_./P.......... �nceto nearest lot line--- Number of pits.-- --------------Lining material_` ._. ____ .G_'!�._Size: Diameter--------------- ----Depth---------- cS-._........ .... Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material------------------------------------ Size: -.._-.. ._---.-. -____-____-____-Size: Diameter--------------------------------------Depth-------------------------- -------------------------Liquid Capacity----------_-------- ---...gals4 Privy: Distance from nearest well--------__---------------------------------------Distance from nearest building.-.---__-_.-_.---_-_-___-.-.-___------.--. ❑ ?istance to nearest lot'lin-e------------------------------------------------- ------------------------------------ --- - --------------- ------- ----- ----- Re delin n /or re ring (describe):-----.-0..®Q _/L.. ------- - %�%�4..... 1 ` ----------- ; ------------------------------------y---_______--.--___----.-_______-___-__-______--_______--_-_--.t._.Y.----_---•-___________-_---__________---_.-_-_--_---.---------------------------------.---------------------------- I -_____-_-----_-.--------_-_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, arid` les nd regulation of the San Joaquin Local Health District. i ;;4 (Signed)------------------ --- . --------------------- By: ------------.` - 74----- - . -_-------------(Owner and/or Contractor) By:-------------- ' Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- �i + -------------- DATE----- R T---------------------------- REVIEWEDBY----------------------------------------------------------------------- ----------- -------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------ ._......_:------------- ----------------- DATE----------------------------------------------- ------------- Alterations and/or recommendations:---q' - -:-- - -------) ----1�1� ---.- -----•---------- - --- --•-- ............. 1 ----------------------------------------------------------------------------------------------- --------------------------------------- ...... ---------------------------------------- -----------------------------------------------------------------•--------------------------------------------------------------g--.------------------------------------------------- FINAL INSPECTION BY:....Q--• � --------------- ---------------_--- Date-----9.__ } SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 9-59 3M 3-'63 F.P.CD.