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FUK UFFICE USE: .._ �-tri`-----�'� -- -. ,�,,,� - -------- Permit l�To:'r�°° -- -- ---- �---. - - .._.. _ . Com f APPLICATION FOR SANITATION PERMIT Pe { p ete in Duplicate) Da I 9 --------- --- Expires to Issued--12=-----&--_ c . {This Permit Ex ires 1 Year From Date Issued; - Application is hereby made to the San Joaquin Local Health District for permitto construct a`nd:install the work herein described.This application is made in compliance with County Ordinance o. 549. ' fG�7Q �� JOB ADDRESS AND LOCATION------- �/ --------••--------------------------- ------------- Owner's Name .117.. :JQalr t ----------- ------- - Phone---. - - ------------------ - Address---------------- ✓` Q.� `C -R - ----- Contractor's Name---____-- ---•----------•-------------•--------------------------------- Phone.--:•-----------------•--•--------- Installa+ion will serve: Residence pa#tment House �c-Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units. __j__ Nu bier-of,bedrooms _-_rNum6er of baths_ Loft sixe ___ 1 - /_____••_ �� ----- ---------- Water Supply: Public system Community system❑ Private ❑ Depth to Water Table .6..!_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ ❑W"'Sana Loam ❑ Clay Loam Clay p Adobe ardpan ❑ Previous Application Made: (If yes,date:__F.....:...........I No New Construction: Yes ❑ No &J-I�HA/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 from foundation----.---------------Material ______._.___--______._.___ - A--------------- e M1 ----------•----- -- -----.Liquid depth--------------------------Capacity-----------= -,c '1 Disposal Field: Dor Distance from nearest weli__________________DiI" mace from foundation____________________Distance to nearest lot line___-____.__.__... Number of Imes--------------------------- Length of each line----------------------- °-:--..Width of trench..----.---------_--- -. Type of filter materia[---:-------------------Depth of filter material--------- -------Total length----•----------__-- � r.t .�.M , . ------------•-------•-- Seepag Ft: Distance to dearest well-___-._:__--X.------_Distanc rom fo dation__- Q -f,Disfian,e to nearest lot line___- - Number of l its - Size: Diameter___-- p �-�---------------Lining material- ly-Q� -�---�----.Depth__��l�c� ' b / c Cesspool: Distance frotrn nearest well-----------------Distance from foundation--------------------Lining material_-_.__.___--__________ -•--- ❑ Size: Diameter.-------I------------------- ---- ----Depth------------------------------------------------------ I. Liquid Capacity-:--------------------------gals._ Privy: Distance from nearest well__________ ________________________ __ _ _Distance-frorri,nearest buildin ❑ # earest lot line-- - g Distance to -----------•--------- ------------------- Remodeling and/or repairing (describe)_______________________ ' ` � iCs ^r! ---1- ---------------------------------------------------------------------------------------- 1 ------•-------------•--------------------- I ------------------------------------ ------------- ----- -----------------------------------=-------------- - i I hereby certify that I have-prepared`this-application-an'd-that-the-work-will`be�done`in-accordante•wif-h San Joaquin County ordinances, State lawsXrullie, lations of the San Joaquin Local Health District, q y (Signed)----- > T { and/or Contrac+or) - ----------------- --- gY: y Title-- _______ _(Plot plan, showing sizof system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- -------_-,.c�„ �f_ -------------------------------------- DATE---- - --------------------- REVIEWED BY--------------------•------- DATE---------- ------------ •----------------------------- BUILDING PERMIT ISSUED---------------------- ------ DATE----- 1. ------------------------ Alterations and/or recommendations:-- __-.- ------- - --- ----- ------------- �` =- = = ----------------------------------------------------------------- ---- ------------- ---------- --------------------- - V FINAL INSPECTION BY_____________ _ _ ------------- Date � � c1/ -- SAN.JOAQUIN LOCAL;HEALTH}DISTRICT 1601 E.Harellon Ave. 300 West Oak Streets 124 Sycamore street 205 West 9th Street ` Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.p,C O. -