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FOR OFFICE USE: 2 - - -/� ---- __..- APPLICATION .FOR SANITATION PERMIT Permit No. ------------ ---- ----- --------------------------------- --------- ----- ---- ---------------------------------- (Complefe in Duplicate) r $� .. This Permit Expires 1 Year From Date Issued Date -ssued ------------------ Y 070- 33 Application is ktreby rT,ade to the San Joaquin Local Healfh District for a permit to construct and install the yv k here describ d ' This application is made in compliance With Co my Ordinance No. 549. Y ��( �a'1ref 6 LLy f r �� —R -Qty�4-S JOB XDDRE55 AN LOC TION--_-- - - ... __ - •C/ - LI��G /y ----- --- �,f� /? Owner's Nam l�� r_ tr--�?. r--------------------------------------------------------------- Phone.-LrG�"' Address 1-1 ( "y' Contractor's Name----- � ,/ t ��Lr Phone -•---------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Otherd5�d�� Number of living units: _.` Number of bedrooms .- °Number of baths -r _ Lot size ----------------------------------- Water _//�- �'�------------------------_---_--_Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table SP .a Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M-_'Hardpan ❑ Previous Application Made: (If yes,date--------------------1 No REf, New Construction: Yes p"'No ❑ FHA/VA: Yes ❑ No [4— 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__4�....--Distance m found�tion__1�--------Made �.-C�_ /"G�� _- No. of compartments--- ------ -------size- - ---Liquid depth_--_ --_ ..----------Capacity-- _- _-• Disposal Field: Distance from nearest well.---s�-----Distance from _. foundat' n_ �_ _ Distance to nearest lot line__'___..______ Number of lines.--. __._-.- ength of each line------ZI ___ ___ _ Width of trench. _ ___------------------------- Type of filter material. epth of filter material___. -__ Total length-_----- -�----------- ----------- ? , Seepage Fit: Distance to nearest well Distance frorn fou - tion _ __,Distance to nearest I t hng_ � Number of pits-_- ------------- material___ __ Size: Diameter.. �.--De th- .. • Cesspool: Distance from nearest well--------------_-Distance from foundation-------------------Lining material-._..-.--- _---____-------_-_----. Size: Diameter------------- -------- -------..De th--------------------------.---------.-------------Liquid Capacity gals, s Privy: Distance from nearest welL_-------------------------_._---.-..-_--..,:_Distance from nearest building--------------.--------------------------- ❑ Distance to nearest lot line ------------------------------------------ ------------- Remodeling and/or repairing {describe): �J - --------------------- �� ------------------------------------------------------- -------------------------------------------------------------------------------------------------- ---------------- - ---- ------- ------------ ------------------------- --------------------------------------- ------------------- -------------------------------------------------------------------------------------------------------------------- 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, an4 rules and regulations of the San Joaquin Local Health District. (Signed)--------- `' --a' w d{or Contractor) rBy:----------------------------------------------------------------- - . ---------------------------(Title) - -'?'---- (Plot plan, showing size of lot, location of sysfe relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ,BY---- - --------- '_ _-.-_: --'---=---------------------------- DATE------ f . REVIEWEDBY ---------- ------------------------------- ------ DATE---•-------------------------------------------------------- a BUILDING PERMIT ISSUED-------- ---- -------- ----------------------------------- ------------------------------ DATE -------------------- ----------------------- - ____. `- s� ie �'Alterations and/or recommendations ��_- -------- ___-- ---------- --- �p - f FINAL INSPECTION BY:.---110 / -- y-------- Date....... ..-.- AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elton Ave. 00 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,Carifornia Tracy,California F.F.0 O.