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F OFFICE USE: 3------------------T.11_30- / Ap-Z/ G��---------------- _ ��e APPLICATION FOR SANITATION PERMIT Permit No. _1_07Y ------------------------- ------------------------------ (Complete in Duplicate) Dat; Issued, _._._.__--------_V ------- _------------- _________.__ This Permit Expires I Year from Date Issued_ Application is hereby made to the Sart Lquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. .JOB ADDRESS AND LOCATION------- 6a- ff �---------------N---------- ko----------------------- ---------------------------------------------------------------------- Owner's Name-----1l-`-----. kj.e7.`.---•------• ------- - --------- ------ Phone_- 4_ _s,S_.►3___-6J_..&1_ Address------------ -•---------- Contractor's Name------J - ---------` �s-----•- --.i-N.. ------------------ --'-- ------------- Phone.... Installation will serve: Residence D< Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _____ __ Number of bedrooms .2—= Number of baths ___ ___ Lot size -----l_Oo----- 1 Water Supply: Public system N Community system ❑ Private K Depth to Water Table __60 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe X Hardpan ❑ Previous Application Made: (If yes,date____________________) NoN New Construction: Yes ❑ No X FHA/VA: Yes ❑ Nox TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation_-.----------------.Material-------.-------_------_-----_-------..___._____- ❑ No. of compartments--------•------------ ----Size--------------------------------Liquid depth--------------------------Capacity-----------•----------- Disposal Field: Distance from nearest well.__ _0.�._Distance from foundation--------10......Distance to nearest lot line------ E,. . Number of lines-------------I------------._______Length of each line------------61,0-----------.-.Widtk of trench-------------- 'r Udo Type of filter material__e_?.o.a_K—------Depth of filter material--------jig"_____,Total length-_____________________q. ---________ Seepage Pit: Distance to nearest well .__1_0_Q_'--___-__Distance from foundation------&0......Distance to nearest lot line------ 00 Number of pits____________________Lining material__r� 1__._.Size: Diameter_____ _s _ -6-Depth_______._ �5__F__________ a�.�ti Cesspool: Distance from nearest we#1-----------------Distance from foundation-----_--------------Lining material__._____-__________._____-__-_______. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well ___-.___________-----------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line---------------------------------- ------------------------------------------------- ----- Oj Remodeling and/or repairing (describe):----------14A4--------6-----ate--x--1-s -I---------•-S.-t-SA5E;`>"ti---=----------------- •-----------------------• V ----•----------------•--.------.------•----------.•-----------•------------- -•-------------------------------------------------------------------------------------------------------••--•----------------------------------- ------------------------------------------- -------- ------- - -------------------------------------- ---------------------------------------------------------------------------------------------- I 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 Local Health District. (Signed)-. ci—.-------1 _C� s_ ---- - -------- _ ------------------------------------Owner and/or Contractor gY= --------C= `r —� '.`� -----------------------------------------(Title)--------- �""`'-`c�•.& (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 APPLICATION ACCEPTED BY------ ------ ---------------------------------------- DATE---- p4 ----- em --------------------- REVIEWED -- ---------------- REVIEWED BY -- -------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------._ DATE------------------------------------- - --------------------- Alterations and/or recommendations:__.__ ___ Y___ !^- .- c~__�'___� Z-__ r� --`---- ------- .... =------------------------- ----------- -- - --------------------- ----------------------•------•------------ -----------------------------------------------------------------••--------••- -------------------------------------------------------•----------•---------------------------------------------------•—•--------------------•-----•----- ------------------------------------------------- ------------- FINAL INSPECTION BY:.---,/s� � ':'rL=--------------------- Date---- 00 Ite SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Are. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED a-S9 3M 3-'63 F.P.CD.