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R OFFICE USE: 3d 7I/�F R_- 1 S -- ----- APPLICATION FOR- SANITATION PERMIT Permit No. >}—' ----------------- -- - (Complete in Duplicate) J V. This Permit Expires 1 Year From Date Issued Date Issued .______�1- S___ 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. 35o --#s'�----`-----� JOB ADDRESS AND LOCATION_____________�__ ---- _ -- ------------------ Owner s Name- I �. - r -------------------- Phone �� '6 ----_/---- tlY T ------- Address = ------ ----------=-------------- ----------• ------------------------------------------------------------------- ---------------------------------- ------ = Contractor's Name f ------ – ----. Phone-----------------------------------�� Installation will, serve: Residence Apartment House ❑ CommercialT❑ ,Trailer Court'[] -Motel ❑ Other ❑ f Number of living units: ..../ Number of bedrooms --- ? Number of baths __ ____ Lot size _-._- D__.-_X", rd__________________ Water Supply: Public system Community-system [IPrivate ❑ Depth to Water Table t7d ff. � Character of soil to a depth of 3 feet: Sand,❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobHardpan ❑ II � r Previous Application Made: 11f yes,date__.__'_____________) No New Construction: Yes El No FHA/VA: -Yes ❑ No ❑ k TYPE OF INSTALLATION AND SPECIFICATIONS: ( (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tapt-c Tank, Distance from nearest well-----------------Distance from foundation--------------------Material_-___�______-_________.._______....________- No. of compartments------ -------------- ---------- q P. -----r------- Capacity--------=-------------- .__Size________________ __Liquid de th___._____.-__ _ V I * / Disposal field: Distance from nearest well. __dl"c_,._Distance from foundation-----/_.___...Distance to nearest lot line___ t [� Number of lines------1•........:.......----.. . Length of each line-----,�__.4_ ______._f_.__.Width of trench-...__�._ ------------------- Type .�-__._________ Type of filter material__�!_9 __Depth of filter material------/g__ _.____Total length-_-------------I__.______ ------- Seepage Pit: Diktance'to°nearest W611= ._Distance from fou dation__Z.<:�>_...___.Distance to nearest lot line----ZO_ Number of pits_______ ___________Lining material___ __F4 Size: Diameter____3-3__ Depth_....R.-S--------------------- LR Cesspool: Distance from nearest well---- ----------Distance from foundation____________________Lining-materia•I'n.-----------.____.______.____..___ ❑ Size: Diameter------------------------------- ------Depth----------------------------------------------------Liquid Capacity ---------------------------ga1s. Privy: Distance from nearest well_______-----__ --------------------------.-------Distance from nearest building____.________::_:___.________.___..___.._. �. . ❑ Distance to nearest lot lire - ----------- ----------------- -------------- 9 an / Remodeling d or repairing describe ________________________________________-______________ { P 9 � �� --- ------ ----------------------•-------------•-•-----------------------------------••--mob ' ----------------- -------------------------------------------•-------------------------------------------------------------------------------------------------------------------------------------------- ------------------ -------------------------------------------------------------------•---------------------------------------------------------------`----------------------------------------------------------------------------- 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)-------- ----- ------- .....(Owner and/or Contractor) B ---- --------------------------- Ti+le --- --- -- - --- ---- (Plot plan, showing size:of lot, location of system :in re tion to wells, buildings, etc., can be placed oreverse'side). FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY------ ... --- - -- -; -------------------------------- DATE-------?----�-----�'�--"-------- ---- -- - REVIEWED BY------------------ � -------- ------•--- DATE------------------------------------------------------------ --- ---- -- BUILDINGPERMIT ISSUED=-------------------------------------------------------------------------------- - ---------------- DATE----- - -- -----------------t----------------------------- r Alterations and/or recomnljendations: ---- -- --:-------- `` -1 i`;_d`E ----- c ----- ---------------- -- ------------- ------ T .--- i-2- -- r f --- ----------�-=s=f----.-�=� - - tee , , = ----------------------- ---------------------------------------- -------------------------------------------------------------------- FINAL INSPECTIONBYc -_t.� Date.-----74_ P "' __ -- - ------------------------ SANOAQUIN LOCAL HEALTH-DISTRICT , 16011.Hazelton Ave.— 300 We t Oak Street� � � • 124 Sycamore Street 205 West 9th Street 4 .a i Stockton,California Lod, California Manteca,California Tracy,California F.F.0 C.