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OR OFFICE USE: --------------------------- j �r / ' c APPLICATION FOR SANITATION PERMIT Permit No. __�..il._.P_j-6 /f .� , . (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued ____f -_ ------------------ - A ------------- -- Application is hereby made to the San Joaquin Local Health District for a permit to constru t and install the work herein described. This application is made in compliance with County Ordinance No. 549. S JOB.ADDRESS AND TION �l?I. --- - -------------' Owner's Name--- • --------------- --------------- Phone-----------•---=---- --°---------- rS = ____________________________________Address----•-14P-o?- -- ------- --------_-------------- Contractor s Name--------- -•---------- -• - •- •-- --------------------------------------•-------------�.�---•------_-------------------- P-one.--------------- - ------••--------- Installation will serve: Residence �partment House El Commercial ❑Trailer Court ❑ Mote��❑ter O�thge�rp Number of living'units: - f__ Number of bedrooms Number of`baths .' _ :Lot{size.-.� sfv-------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water TableQ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam E] Clay;Loam lay ❑ Adobe E] Hardpan ❑ Previous Application Made: {1f yes,dote------______--------) No,�/ New Construction: Yes �No ❑ FHA/VA: YesZ?"No ❑ ��11 � Iv TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public ee sewer is available within 200 ft.) J `U Z Septic T k: Distance from nearest well_-_(!?? _.-_.Distance from,fosu�nndation___/r ____.Material-- -_ ,f' ___________________ No, of compartments__ --_-/- ___'Size-!1k_�14-quid depth_•__' -�_____________Capacity_? Disposal ield: Distance from nearest well/f?,�,, --.-_Distance from foundation_ -��__-_-Distance to nearest lot line_ �._____ Number of lines_____ __� Len th of each line__ ------- Zy Width of trench,r -�____-_- : g �v Type of filter mnal_ Depth of filter material length__ o --r ___________._________--_ Seepage Pit: Distance to n forest well e,0_____Distance f m fo dation_._�Q` __.Distance.to nearest lot line_ __________ (fes y -Linin material-- --Size: Diameter--Z . -. _ De th Number olpits. 9 - p ` Cesspool: Distance from nearest well-------------____Distance from fou ndati __ on_ .i______- ------ material--------------------------------------- �. ❑ '; Sizer iometer------------------------e-------- tDepth,--------------------,----- �- !-----Liquid -Capacity----------------------------gals. � 3 Privy: f t.Distaricefrom nearest well___ `__:_ _ ____ ________ ____Distance fromearest building_________________ __.________-.___- 1 [� *Distance to nearest lot line-------- -- ----------------- ------------- Remodeling and/or repairing-('descriLse)::--~�~" -=------- _ = ----------------------• -- -------------------------- ti----•-- ---------- "-------------------------------------------------- I---- ---- -- ---------------•------------------ -----------`-------------- ------------------`-------------••-------------------- ...._ --- --- ---------- I 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, and rr les and reulation of the San Joaquin Local Health District. . (Signed `~% � Kaer /or Contractor) r By:-------------------•------------4---------------------------------------------- ------------- (Plot ------(Plot plan, showing size of lot, location of system :in rel ' n to wells, buildings, etc„ can be placed"on reverse side). ..� ' FOR DEPARTMENT USE ONLY _ V APPLICATION ACCEPTED BY---- -------------------------- �~ r BATE _ = REVIEWEDBY------------------------------------ ------------------ - ------------------ --_----------------------------, DATE---..--.----------- "------------------------------ BUILDING --------------- ---`----BUILDING PERMIT ISSUED------------------ -------------- ---- .---- r DATE----------------•------------------- ------ I ------------ Alterations and/or reco mendations:._____.__ --Z� '-`'s "f`" �" �1 �� 4 a .-/ - C� -� Gae 2� _ --------------------------------------- * ------ h - -----------J- -------------------r----------- ° 1 f= ---__---:---_----------- _ r �-- r 5 � .7l�c�i r* -----• -a` - : --" � xerZ✓ FINAL INSPECTION BY:........ Date----------- ------- --- ----- /---t------ --------------- S N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Fia:eltan Ave. 300 West Oak StreetSycamore Slreet q 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISEC 8-59 31A 3-'63 F.P.CC. i'