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FOR OFFICE USE: / ------ �1_��6_J_____-_-___ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------- - -- --- -- -- Date Issued ______ (Complete in Duplicate) GG 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. rr�� // //�� aa rt t JOB ADDRESS A OCA ON__iCi.b_T_T .- o j �� ------- -----------------------------------------------`'--�'c=f°--h � f Owner's Name - ! h U {_ ��---------------------------------------------------------------- Phone.................................... Address---------------��__ ... .6 j ` r Contractor's Name - 7v Phone �l--F� �� ' Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __/- Number.of bedrooms J9---_ Number of baths -4'-7 Lot size _______�"__!�� -�_________________________ Water Supply: Public system 9 Community system ❑ Private ❑ Depth to Water Table _(aO 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 ❑ 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.) Septic�Tank: Distance from nearest well_A-0—�f'___Distance from fou dation__ q•-________-Material-______ __ —_____ - ---------- XNo. of compartments___ra2_________________Size__-�..A -"Liquid de th_____ 8_" Capacity..,/ Disposal Field: Distance from nearest well_ e'er---Distance from foundation__..4._Q.......Distance to nearest lot line____—Z_a..` Number of lines__________ __ ____________Length of each line_______©_` �� Width of trench------- �.................. Type of filter material_ ,_____Depth of filter material____1_ ------------Total length......... __ -_------------•---- Seepage Pit: Distance to nearest well__/ o16C'_______Distance from foundation__)©_e_^____.Distance to nearest lot line____ _©.' V i Number of pits------I--------------Lining matenal__Rbd),--o ____-Size: Dia meter__.�>3-°_•------.Depth__-___�_�_ ------------ Cesspool: Distance from nearest well-----------------Distance fromundation--_-_-________-___-.Lining material__--_____________-____________--_____. ❑ Size: Diameter--------------------------------------Depth---------------•----- ---------------------------__Liquid Capacity---------------------------- Privy: Distance from nearest well------------------------_------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line----------------•----------------------------------------------------- '��— r Remo i and/ r repairing (describe):----"�----`�' --- -- - B -a?--•-- -•--f •--_----------- ---------- - ------ ------------------ - - �`� - •--------• --------••---------•---•----------------------------- ------------------------- 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, anc�es�jagnd regulations of the San Joaquin Local Health District. � (Signed)-------------------- �/�//i �i#----------------------------------------------------------- r Contractor) SEWrIC TAfNK <✓Ir-.- (Title) By:. 9©5 ---'-f7if 4%--G ------- - -------------- (Plot plan, showing size of lot, Inca+ton of system in relation to wells, b ings, etc. can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTS Y__ - .__ _ ---. DATE - --------------------------- REVIEWED BY --- yv�goe— ,__ -----� - ----`----^'---'_= DATE Cj --------------------------------------------------------- BUILDING PERMIT ISSUED------ ----------------------------- ---- --------------------------------------- DATE_--------------------- Alterations and/or recommendaf ns______ _______________ ----- --------------------------:_------�----- ------------�7= ----��----------------------------------- ----------- --------- ----- ------ -- - ---------------- ----------- ---- - ------------------- --------------------------- ---------------- ------- --------- - ------------------------ FINAL INSPECTI BY- ----- ---- Date-------- `�_ � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E8-9 REVISED e•69 F.P.CC.2M 6.60