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f FOR OFFICE USE- ' '47 _ r �. v L-- ----------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.l�� 1 _. --------- -------------- ---------------.. (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued lQ-- —�5— - Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and -install the work herein described. This application is made in compliance with County Ordinance No. 549. ----- �- �" Q ---------------------------------------------------JOB ADDRESS ANDLOCATIION.-7�T- _ i G7 ...........-Owner's Name----- •------------ --- --------------------------- ------------- 7 ----------- Phone -J•� cA � LL� -- --- ---Address F •--------k--- Phone &4?T&07 Contractor's-Name_"" _"::TAk . --------- = = Installation will serve: Residence! Ik Apartment House ❑ Commercial E] Trailer Court ❑ Motel El Other ❑ Number of living units: __(- `N_umber of bedrooms __Number of baths _.!---- Lot size --------------------------- Water Supply: Public system ❑ Community system ❑ Private [Z Depth to Water Table SV ft. Character of soil to a depth of 3 feet: if Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clby ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes ciate--------------------1 No K� New Construction: Yes ❑ No FHA/VA: Yes ❑ No J� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank,or cesspool vpermitted if public sewer is available within 200 feet.) ' ( Septic Tank: Distance from)nearest well----------------'Distance from fo -1 undation;-._-_------_-'-Material-..-----..------.--------Y----------------------- i. ❑ MS"C_ No. of compartments --------i Size-----s I Liquid depth__.. ------------"- Capacity---------- •----------- ` 7S— r Disposal Field: Distance from nearest well-.1A• __:IDistance from fund i •S - Distance to nearest lot line--------------- :. . r------- Number of lines--C"' I Length of each line-- -.- -- ------- rWidth of trench_•--�a rr --------------- ! Type of filter material- (.". --- Depth of filter material -------------Total length_- -------- terial Ilk Seepage Pit: Distance to nearest well--�/L ------Distance f om foundatio> ": M.D t nt�e to nearesty�lot lisn�e", -- Seepage ---.- Number of pits..& --------Lining material_-- ---if.� _.Size: Qiameter`..............r.-'"-".Depth :._----"- .--.,.__...- Cesspool: Distance from nearest well-----------------Distance from foundation.------------------Lining material--.----. -------------------------- El --__- _--------.❑ Size: Diameter ----------------------- Deptht �--- - ----------------- ----•-------------------- -LiquidCapacitY gals. .Distance from nearest building Privy: Distance from nearest well- -9-n_--=----- -----"--- ------ - ------ _ 9 ------------------- ❑ Distance to nearest lot line!` ------------- -------------------------------------------- ---- ' ----------------------------------------------------------" Remodeling and/or repairing (describe):-- .-.-----_-_----- ---- --------------- ---------I- ----------- -•-----------------••----------- --------------------------------- ------------ ------------------------------------------------------------------------------------------------------------------- ------------ ----------------------- - - - I hereby certify at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s and r4andlations of the Joaquin Local Health District.5i ned --- r -- ---- weer and/or Contractor) ( 9 )------------------- -- - --------BY• ------- --..rile f ....... I (Plot plan, showing size o�cation of system in relati n to wells, buildings, etc., can be plat on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED �BY__ -- ------- --`----------- DATE - - - -- --- s REVIEWED 13Y"- ------------- - ----------------------------- ------ DATE BUILDING PERMIT ISSUED--------------------------------------------------------- ------ ------------ DATE �C-- -`�' `_ `lac-(�" Alterations and/or recommend tions:.---_. �--.�--------�-- -- ---;------------ ---------`�-----�------)� -��- r `^ � ��-`------ , •l------------------------------------------------------------------------------------------------_----------------------- t FIS `' ��' _:�... . Dae------- fr---:_.- AL INSPECTION BY: - -- �- - ---------- ---------- S N JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.