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FOR OFFJCE USE: --------------------------------------------------------- S~ __.._._ _ _______.: .-_____________________- APPLICATION FOR SANITATION PERMIT Permit No. .. . . ....... . "Y"�---,------------------------ (Complete in Duplicate) y ----.--- This Permit Expires 1 Year From Date Issued Date Issued �--?-0 / 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. S49. A4#gNTjECM CTI JOB ADDRESS &ND PRF L^O'CATION v �^1-----13— --------- �L�L�-------------�..... �1=---------•-�-�5 Owner's Name-------------•<�1 -6---------D E_v.R._LO( :a--------------------------- --------------------- ---------- Phone--------------------•--------------- Contractor's Name------q......F_ •--GA-1G-0-4ZE- ----------------------------- ------ •--------.---------..----- Phone................................... Installation will serve: Residence ®—Apartmdnt House ❑ Commercial E]-,," er Cpurt ❑ Motel ❑ -Other ❑ Number of living units: -_/____ Number of bedrooms __3 Number of bahs 2 - o#size R _________________________ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Tabie.., .._ft. 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 E2---New Construction: Yes P-<O ❑ 4MA/VA: Yes ❑ No 91--- TYPE OF INSTALLATIOWAND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.')' Septic T nk: Distance from nearest well___ ____Distance from foundation-___. ___Matemia(C4n1CT -_---•_-.-- pV No. of compartments--___-.--�---------Size.-�_4X 1a_X_57�..Liquid depth::-��_X?.--------Capacity.. 0.O_. Disposal Field: Distance from nearest well__5 0__.._Distance from foundation--- ...__.Distance to nearest lot line-_..___.__. Number of lines.......... --------------------- th of each-line Length Width of trench ------------ h Type of filter material___ .GC-/��-Depth of filter material___ _: --------Total length___ :: $____________________ Seepage Pit: Distance to nearest well---,5--Z:)-------- from foundation__1.16........Distance to nearest lot line___._..__._ ZD_! Number of pits------- ------------Lining mate ria 1_.,60_ _Size: Diameter_TX_ __Ei>-_-_-_Depth_...___�___---------_------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- •r ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------,Liquid Capacity----------------------------gals. 3. Privy: Distance from nearest well_--_-.----------------------------_------------Distance from nearest building------------------------------------------- Distance ______-.--_________.________-._-_._--.Distance to nearest lot line-----------_------------------ Remodeling and/or repairing (describe)-------------------------------------------------------------------•-------------------------•--- ------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- ----------------------------------------------------------------------•-----------------------------------------------------------..................................................---------------------------------- -------------------------------••-----------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------- 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 f the San Joaquin Local Health District. (Signed) --------- ---------------------------------- -------- ----=----- ------ ------------(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------�-'--1p--.a-=--------- ----------------- DATE------- _a_ REVIEWEDBY------------------------------------------------------------------------------------------------------------------------- DATE-------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE... Alterations and/or recommendations:-----------------------------------------------------------------------------•-------------------------------------------------------------- -•-•--------------------------------------------------------------------------------------------------•--------------------.------------------------------------------------------------------------------------------------ ----------I-------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- ----------------------------------- ------------------ ------ � ----- ----- ----- --------------------------------------------------------------------/---------------------------------------------------------------------------------------------------------------- FINAL INSPECTION a- ------- --- - -- Date 1 - SAN JOAQUIN LOCAL. HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 12f4pWamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, iifornia Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CO. i