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rvR vrritC UAt: ----------- -------------- ---------------------------------- ------- I k-, APPLICATION FOR SANITATION PERMIT Permit No. f -- (Complefe-in Duplicate) --------- This Permit Ex fres I Year From Date Issued Date I / Application is hereby mads to the San Uoaquin LocalHe h District for a permit to construct and install the work herein described.This applicati�n i� made in complia �ou Ce /If 5jb� Rq� M�4nt7icr9 JOB ADDRESS AND LOCATIO , y ------------------------ Ownerr's Address �7..�. 1 - - Phone--------••---•-----................ l ®- HIS- `= Contractor's Name---h1ArYTrm -----------------------------------------------•-------------------- ------------- ,(4: ��-�-1�- �_��G� . ............................... 3-Phone-----------•---------•-- Install•a+ion will serve: 'Residence ❑ Apartmeirif'H6use ❑E Commercial railer Court ❑ Motel ❑ Other ❑ , I Number of 4vkmy unifr..__/____ Number of bedrooms ----- -- Number of baths __Z Lot size __. =1 Water Supply: Public stem ----••---------l--`------------- ,`-• PPy� y ❑ ...Community system ❑ Private Depth to Water Table __�_ ft.` Character of soil to a depth of 3 feet: Sand Gravel tj Sandy Loam [] Clay Loam ❑yes, Clay Previous Application Made: {!f date..._.___ �____ [I Adobe E] Hardpan E] _ No New Construction: Yes1�No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No. septic tank'or.cesspool perrrtifted,if public sewer is available within 200 feet.) Septic Tank: Distance from nearest w0_50-....Distance from foundation---�1 ---.....Mat ria -ED. 'I(?Q No. of compartments.____' -."--_Size_ ___XlG'_X"" Liduid`depth__-" . ------Capacity 7 Disposal Field: Distance from nearest well._ r! __ Distance from foundation.____ -_.Distance to nearest lot line___ ®� Number of fines"-:_____�------- --------------Length of each line______" ` � g ��-'------------ -.Width of trench-------r�-.-r�----- ----( 0 - _Type,of"filter material___ __ 49G�'�,---Depth of filter materia!___.-��-sc"_---Total .length-------------------��---- --_"_"-- I + ❑ Number.of pits---i_ __""�__*__"""Lining matarlace from foundation---------------------Distance to nearest lot line__________.__._._ (� Seepage Pit: Distance to near t well.____--. _------------ p i� IDrstanl -.--- Size: Diameter, --------------Depth-- ---------------------------- Cesspool: ! De Depth ------ -------- -------- -- Distance from net p - ,---. ng material---,----- "--- % arest well_��__._____..___Distance from foundation_".____-_"__ 3 tr. i ----- El .K Liquid Capacity=r -------- Size: Diameter--_-'I gals. Priv rest well------ r G -- ---i_bisfance from nearest building__-_____-------- Distance to nearest lot line------ -.:.- _ rk _________ __________------------- Remodeling,and/or repairing (describe)--------------------"----- - --------------------------------- t • '! ----•------ - ;. t ------------------------------•--------------•-------------- ---------------- -------------- ----- i1. ---------------------------------------------------_--------------------------- ...... --------------- - - - -- --'re-- -- is__a-•-------------1-----•--------:------------=-----------------------------------------------------_------ --------- ---------- ------._.I hereby ce fy that I have prepared this applica+ion and that the work will be done in accordance with San Joaquin County ' ordinances, St laws,�Ad rules ndli!SSrre la 'ons of the San Joaquin Local Health District. ( • - 5t ned t-R Signed)--- ------2- -------------------------------------------------(Owner Bfi ize---'------=------•-- -----`--------------------------------------------------------------------------------(Title)------------------- ------------an----and/or Contractor (Plot plan,"showing size of lot, lots`}io of'systeri� in=relation to we11s,^buildings,=`etc.;can be placed on-reverse side): -+-� FOR DEPARTMENT USE ONLY APPI_ICATIOWACCEPTED;BY_-7-_ _ ._ ._' �.- +.. :- _ ------------- DATE--------- a REVIEWED BY -1---------------- - BUILDING PERMIT'ISSUED - ' --P ° - DATE-- _- ` � v _ - --------- --_----------------- ----------------- DATE-_---.:.------------------- -Alterations and/or recommendations:_---__.___-..__ "_-------------- -------- -- ------------------ f --------I•-------- --------------------------------------•-- ---- -----/---- -- ------ i - FINAL INSPECTI :@N BY; - ---- - Date---- -- ------ -•-------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxelton Ave.' 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3•'63 F.P.CrI.