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FOR OFFICE USE: ------- ?9 II- APPLICATION FOR SANITATION PERMIT Permit No. .... � --------------------- . �_ (Complete in Duplicate) // / --- ll -------------------------------------- Date Issued _:____ ___ . .--__- ---_ _--- - -------------------------- p. This Permit Expires 1 Year From Date Issued �p,,�r �0Z-d-(0 -f�F Application is hereby made A the San Joaquin Local Health District for a per t construct and insf3ql the work herein described. This application is made in cor"hrtpliance with County Ordinance Na. 549 ' _ ak j— �C?bQ S 1 JOB AD- DRESS AND LOCATION--_---- _ ' Owner's Name Phone------------------------------------ Ai Address 19 2 -------••------------------•-------------=--------- - �j� �- ` ---.- Phone447--ZIs,/(,/ Contractor's Name. I + ;1.L •e • Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units lil!-�-.--- Number of bedrooms -----�._ Number of baths ..-1-,- Lot size __________ ----- I Water Supply: Pubiici system .❑ Community system private ❑ Depth to Water Table -------- ft. ; Character of soil to a depth Iof 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam�W"EY3 Cl ❑ Adobe Hardpan ❑ s II New Construction: YesFHA/VA: Yes ❑ No ❑Previous Application Made: (If yes,date_.............._--1 No ,I i TYPE OF INSTALLATION AND SPECIFICATIONS: r - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .11 , � o � f Septic Tank: Distance.1from nearest welL _ t .__-Distancf om f ounda. ion__._� / 4 y�, (� Material--- _�.r C-� p No. of c¢mpartments----- ----------Size_ -- ----�-----Liquid depth-----a _ -------.-Capacity--.I- Q�-- � x * Q Disposal Field: Distanceirom nearest welL_.ECI?.:_Distance f;Pm founda ' n---__�_ Distance to nearest lot line_____. C3 .r� Number of fines------ Length of��acri�i`n�e� _-- -.- - �W,dth of trench-_�u- JJ ` t �,� i /! ; 7 ` Type of filter material-_-- ____________ Depth of filter material---------1-�----Total length--------------------------> ------ h a Seepage Pit: Distance lto nearest well----------------------Distance from foundation______...______.___.Distance to nearest lot line---------- - ❑ Number of pits---------------------Lining-material--------- -----------.Size: Diameter------------------ ----Depth--------- ---------•--- -- El - i J -, _ , Cesspool: Distance l from nearest well_-------______-.Distance from foundation - material------------------------------------- I -------------------------------_ _- v ❑ Size: Dia'meter-------------------------------- `- p _ q Capacity 9 F ---,.Depth - Li uid Ca acit gals. _- I - Privy: Distance from nearest.well _.________'-M1-� --r_`-------------------Y--Distance from nearest building.:___..___.__._____________.____..__-..-. A� ❑ ------------------------ l" Distancel to nearest lot line ` ; Remodeling and/or repairin (describe ----- -•-- ----- - w_ -fr -- t ,Et ✓ - ------------- __. ------------------- AP _ ____=_._6___.--_________._--___-____---.._-_---_-__-___---____-__------____-_---_-______---_---__-----------..___-.___ --------- ---------------------- ? -----..__--__________..._______ ------- ------------ _ ._ SII, ------------ --------------------- ----------•---------------------- ------yr----------------------------- — I f I hereby certify that I Have prepared this application and that the work will be dorie in ac rdance with San Joaquin County ordinances. Stat s, and rules and regulations of the-San Joaquin Local HeV,44 istrict. (�or Contractor) (Signed)------ Title BY: -------------------------------------------------- -------------- - nc ., [ an showing size of lob, location of system in relatio to wells, buildings, n be placed on reverse side). 1 [Plot pl g q� FOR DEPARTMENT USE ONLY APPLICATION-ACCEPTEi)��BY---- ------------------------------------------- ------------------------------------------------ DATE------------------------------------------------------------ REVIEWEDBY----------------------------------------------------" --------_------------_----------------------------------------------- DATE------------------------------------------------------------ : PERMIT ISSUEDIG = r�r DATE-------- / C�------------------------------- il f1 Alterations and/or recommendations---------------- ------------------ - --------------• / IIII -----•------------------------------------------------------------------•--- --------------------------------------------------------- -- IlG ------"---------------------------------------•--- :I --------------------- --------------------------- ----------------------------------------------- WII J FINAL INSPECTION BY.: ------ "----- --=- --��-- ------ Dat SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. . 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California : Lodi,California Manteca,California Tracy,California C6 9 REVISED B-59 3M 3-•63 `Ilr`.P.CO.