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F�R FFICE USE: / f/� / ---------- --------------------------------------------------------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------- ..........9 - ------ --- -- ----------------------------------------- (Complete in Duplicate) ____ Date Issued A lication is harsh made to the San Joaquin uP Loctal Heal}Expires 1 Year From Date Issued O t�7-�rv,�o� pp y g h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ?,o +�Q Z 4 tl {o JOB ADDRESS AND LOCATION.-o2---_____-_. ^=O�_" °'.. -_-" --_--- i1C,�f �. �Ge ® rye, Owner's Name---f , // �� p�a-'�pC -------------------------•------------ ..... Phone------------------------------------ Contractor's Name-----:- _L S' Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j___ Number of bedrooms __3___ Number of baths _/_____ Lot size �_(--------- -� Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table --4------ 0 ft. �� C Character of soil to a depth of 3 feet:I Sand E❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: (If yes,date___.--._--- "-.___-_) No New Construction: Yes M"'No ❑ FHA/VA: Yes ❑ No �Q 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__SQ-------Distance from foundation_-_� _(--------Material----- . .-.________- ®' No. of compartments------'L--------------S"ize...... --------Liquid depth-----9------------------Capacity...keel-' Disposal Field: Distance from nearest well_.1��._---------Distance from foundation.��..............Distance to nearest lot line______.___... ip Number of lines------- Length of each line-_-73. ---------------Width of trench__.�9"__-_________- _-_-_- Type of filter material-3-7-66"----_---Depth of_filter material___I f_------------- otal length-------J>-:-_--_____ ------------- Seepage Pit: Distance to nearest well_-" Distance from foundation--------------------Distance to nearest lot line._ __.i�______ A- Number of pits------. ...........Lining material_ vG'E_-_--..Size: Diameter._.--:V--.r_..----Dept h..........1Z.0--------------- 1 Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-----._____________._____.___--_-__._ Z ❑ Size: Diameter------------------ - ------" --------Depth--------------------------------:----------- `--=--Liquid Capacity----------------------------gals. . Privy: Distance from nearest well-__--------------------------------------------.-Distance from nearest building.:_______.___________-__-_.______..______- ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):----------------------------------- ---------------------------� .----------- ----•---------•--•------------------•---•---------------------------• . -----•-- -----------•---..---------------------------------- I------------------------•------------------•---•--------------------------------------------•------------.--------- ----------------------------------------- }. t 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 re ations f the San Joaquin local Health District. {Si ned �3 )--------------------------------- -- -------•-y--- --------- --------------- -------=--- - ------------------------------------------------------(Owner and/or Contractor) , By:-=---------------- ------------------------------------------{Title)------------------------------------------- - - -------- ------- ----------- ---- ----- --- - ----- (Plot plan, showing size of to , ocatt of system in rel tion to wells,:bttildings, etc., can be placed on reverse side). r } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -• -- ---:--- ------------- ------- 1 / DATE"-------(�" REVIEWED BY ----------------------------------- - DATE BUILDING PERMIT ISSUED---------------------------------------------------`-------------------- -- --------------------------------- DATE----------------------------- r 1,�, Alterations and/or recommendations-1__...__.___1Y1 -- ]!�--- ------------ -- - ------- . -------- .......... ------- V. --------------------------------------------------•------"---------- ------- -------------------------------------•-------- ---------------------------••------------------------------------------ t ----------------------------------------- = ----------- FINAL INSPECTION BY:...C.,----- -------- _ t _ _ Date------7------------2- 4• s :4 = SAN 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 8-59 3m 3-'63 F.P.CC.