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FOR OFFICE USE: _. -------_------------.--------------------------------- AP LICATION FOR SANITATION PERMIT Permit No. . --------------------------- ------ -------- ------------ (Complete in Duplicate) Date Issued /d _______________________________-----_____________________ This Permit Expires 1 Year From Date Issued ___.___(-�.— 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 iXompliance with County Ordinance No. 549. /V MITI 01 JOB A IIU �1Df 111PC►R'J— W1 / j S A S O W O ADDRESS AND OCATION 1 Ilk V---�---- CF T>'�N� RD TATS( I� Owner's Name _` .F..----•-•--NN. �- Phone ' O Address " `r--.......------ }-r�ir Contractor's Name---�' 'A .---------------------------------------------------------------------------•----------------------------. Phone................................... Installation will serve: Residence Iq' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:;:_____ Number of bedrooms _'3_. Number of baths/------- Lot size -26.Q---X- __________________________ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table _J.~.__-ft. Character of soil to a depth oft feet: Sand WGravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application'Made: yes,date---------------.....) No 0---New Construction: Yes [Lr1Qo ❑ FHA/VA: Yes ❑ No }---- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance fr6m nearest well____-__Dista ce from foun ationlP-_-__-- _Mate ial-_-CVNcK1=r>= No. of compartments----Z __________ XAV � — X � 3� -_-__ py.. Q .__-.__- Disposal Field: Distance from nearest well... !. . Distance from foundation Distance to nearest lot Number of lines___._.. .00 Length-of each lrne___ , �r; Width of trench. _. . -. __--. ,S Type of filter material.__ Gt -----------Depth of filter material___.�� ..__------Total length-______-_-- .. .. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- ElNumber of pits-------------------------Lining material_._ >,.....Size: Diameter-----------------------Depth--------------.------------------ 7 Cesspool: Distance from nearest welt ----- :_Distance<from.foundation._______ t p ----.Linirtq_material.-------•-----••-----------•-----•-•- ❑ Size: Diameter--- I--------------------------------Depth -•--- - ---- -- - - ---- I Liquid Capacity ----•-------------------gals. Privy: Distance from nearest well . _. -__ _ ______________ ______ _Distance from_nearest building---.:_._-___-___________---_-_-.---._.-. ❑ Distance to nearest lot line -•----- =------_ -----F------------------------------------- h, --- ---- ------- ------------- /I +. . Remodeling and/or repairing (descril*e):----.-W-------6cX......ZRCFC----VF---- fly` ._..._ T r�r-------------------------------------- ----------------------------------------------------- .... .. „•-«--<--- ••<-•------•...__ . .....<... ....�n, f --------------------------------------------------------------------------------------------------------------------------------------------------------' 4------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accgrdaipce with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. s Si ned d-/ y r-r --- �-��- -- ------- ------ --------------------------------- ---=---(Owner and/or Contractor) _ �-------------------------------------------- - ------------------------------------- --- ------ (�1t1e1: ------ (Plot (Plot plan, showing size of lot, location of systgm_in relation to wells, buildings,_etc.,. can,be _placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----7-7T— l-s-0------------------------------------------------------------------ DATE.---- ----------------------- REVIEWEDBY---------------------------------------------------------------------------------------------------------------- ----------- DATE------------------------------------------------------------ BUILDING.PERMIT ISSUED--..........................---..............._------_---------------------.-.._- -----_• DATE..............._ _s .. ............................ Alterations and/or recommendations:.-------------------------------------------- ------------- ------------------ ------ ------ ----- •............ ........... ---------------------------------------------------------------------- ------- ----------------------------------------------=---•-•-=••-.=-- --•- --------- ------------------------------------------------------------ ------------------------------------------------------------------- --------•---------------------------------------------------------------•------------------- -----•------------------ ---•-- - - --------------- -- --------- ----------------------- ------ ---------------- ------ -. G� // FINAL INSPECTI -------- Date-----------// ._------ 6 FINAL JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California^ Manteca,California Tracy,California ES 9 REVISED 5-59 314 3-'63 F.P.DD. 1