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FO OFFICE USE: Permit No. .,� '5b APPLICATION FOR SANITATION PERMIT ---- - - ----- -- - ------ ------------ ------- / - - -- ; (Complete in Duplicate) - Date Issued ---. ' 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 inst ll the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.-_�_4_4 ----- ;: ) , I� = ------- Phone---------"-------------------- ✓ A ' � ------ ? ® �I Owner's Name__:___ .. � _ s. '_, ,5'=__, ------------------------------------------•----- ... Address. , one -----•---------------•----------- Contractor's Name Ste-% j----Z- -------------------------------------------------------• - - Ph Installation will serve: Residence ®—'Apartment House E] Commercial ❑ Trailer Court. E] Motel ElOther ❑ V f t ---------- Number of living units: ___ _ Number of bedrooms _' ___ Number of baths _ _,_ Lot size ___--- -- - - --- Water Supply: Public,system Community system ❑ Private ❑ Depth to Water Table 9cS"`f�t. y + s Gravel Sand Loam ❑ Clay Loam ❑ Clay ❑ Adobe[Hardpan ❑ Character of soil to a depth of 3 feet:.. Sand ❑ - ❑ Y � Previous Application Made: `l yes,date --� '�' ) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No 0— TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank:or cesspool permitted if public sewer is available within 200 feet.) r ------- 'r--. Septic Tank: Distance from nearest well____ ---Distance from foundation No. of compartments '�- . Size - -1�-- Liquid depth �l - Capacity, { Disposal Field: Distance from nearest well___ .__-----Distance from foundation___fi7_.�" Distance to nearest lot line_ �f____. ❑ ` from -t-eir --.W.idth of trench__ � � ------- Number of lines----------- ------------------ -Length of each line/V0- A --Total Ian' Type of filter mat}iWlof filter - g � X D stance nearest if e ofromfoualon_/k_____. Seepage Pit: Distance to nearest DStan Depth _ L Number of pits.---"�-- -- -----Lining material----------------------Size: DiameFerial ______ rest welL____-.______.__Distance from foundation-------------- Ln Cesspool: Distancefrom nea - ; gals. Size: Diameter---------------------------------------Depth----- ---------=--------------------------- ------ iquid CapacitY------- Privy: Distance from"nearest well______ _ -----------------Distance from nearest building---------- -----------------=---- �- ' -------- O t ' i ❑ -------------------- Distance to nearest lot ine________________________"--------------------- - to- Remodeling and/or repairing (describe)----------------------------•------------------------------------------ --=------------'---------------------------•------------------------ .r" t. -------- f ------------- ,�.- ------------------------------- ----------------------- --------- 1I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ' ordinances, State laws, and rules and regulations of the San Joaquin Lotal Health District. — "� G,F e ------- ----------------------------1_____(Owner and/or Contractor) �G ;JCS 3 e - ----- --- - -- ------------•-----------(Title)-----------------=------- ---------- --------- By:----------- ------ - i (Plot plan, showing size of lot, location of system in relation to wells, buildings,-etc., can be.placed on reverse side). FOR DEPARTMENT USE ONLY t _ S DATE_. ---"S l APPLICATION ACCEPTED BY_..'-------------------•-----.-----"- ij II! DATE - ' ----------------------- BUILDING PERMIT ISSUED- ------t,---------------- - r REVIEWED BY----------------------------- --- ------ ----------------------- ---N=-------=------- DATE ----=- Alterations and/or recommendations:-- ---- ----------------- - - - - ...._ - --- ---- } = ----- ---`---------- =---------------------- -€--":------ --------------------------- ------- ------- --------------------- - i - - - --- - , -------------------------------------------------- 1. _______ - ate - - --- FINAL INSPECTION BY:_.__..:�__-_. -- -- SAN JOAQUIN LOCAL HEALTH DISTRICT, 1601 E.Hazelton Ave. 300 West Oak street 144 Sycamore Street 205 West 9th Street Manteca,California Tracy,California Stockton,California Lod!,California Eg 9 REVISED 5-59 3M 3"'53 F.P.Ga.