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O FFI ELISE: x ..=- : - ------------ r --------------------- ------------- ------------ APPLICATION FOR SANITATION PERMIT Permit No. .f ------------ ----------------------------------- -------- (Complete in Duplicate) : This Permit Expires ] Year From Date Issued Date Issued ._!(-_y7 Application is hereby made to the Sen Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County,Ord inance No. 549- a JOB ADDRESS AND LOCATION.. •� __?-_ --___�� ,l/' Owner's Name_--------- k,R ---'-------------------------------------- ---------------- Phone------- ----------------------------- Address------ Contractor's Name--.---- .-__ _______ -_- -------- ••---------- Phone-- -- -- - � -S -z Installation will serve: Residence [�part enc House ❑ ommercial ❑ Trailer Court p Motel E❑ Other ❑ { Number of living units: ___/---- Number of bedrooms _-VNumber of baths /---- Lot size I Water Supply: Public system Community system ❑' private ❑ Depth to Water Table - + t. Character of soil to a depth of 3 feet: Sand El Grave l ❑'-Sandy Loam❑ Clay Loam ❑_Cla Adobe ` Y ❑ EF-Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 0—New Construction: Yes No El FHA/VA: Yes E] No [� TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi T nk: Distance from nearest well-.!-------_..--Distance from foundation /0 e .3" •-- Mit�la'1-: _:---------- .: No. of compartments---- ----------------Size--- - -fix_- --Liquid depth------- - -- ---------Capacity----_041 ' +� ' Disposal Field: Distance from nearest well--r_.--.-._`.Distance from foundation- 74_r.____-_Distance to nearest lot line_.--_------------ '_ Number.of lines---erial- Length of each line---/_-D_�------------- Width of trench-----cr2- ---------------- Depth ------ y,� „f Type of filter material-__LZ 4_�_ _.______Depth of filter material-� _` --------------- Total length--- -- -=-�-�-•-------------------- Seepage Pit: Distance to nearest well--- _-----_--______Distanc from foundation_--- - d-` T _ Dista Yce to nearest lot line---S__------ Number of pits...:------------------Lining maferia 6__e 1l`-.--_Size: Diameter--- C.esspool: eter__Cesspool: Distance from nearest well-----------------Distance from foundation----------_- -- - ---.Lining material---------- -------------------------- 0 Size: Diameter----- --------------------------------Depth----------------------------------------- -------- -Liquid,CapacitY gals. ------ Privy: Distance from nearest well-----------------#•___--------------------------Distance from nearest.building-_------_-------__-___-_:__ Drstance to nearest loft line------___________'--._ ? ------------------------- ----- ------------------- ! r, Remodeling and/or repairing (describe:----------------------------- - --------•--------------------------------------- --------••-------- ---•-------•-------------------------------•--� --------------•------•--------•--------------- -------- .� --------------W---------------------------- I hereby certify that I have prepared this appl' ation and that the work will be done in accordance with,San Joaquin County ordinances, State laws, and rules and regula ons the Sa Joaquin Local Health District. _. s` 1 .c (Signed)-----x-••----- ------------------- •-:--- -------- ---- ---- -- - ° / ------- ------ ---------------------(o caner and/or Contractor) By:. ----- -- y t i ---------- (T 8y: l a -(Plot plan, showing size of lot,�focati of system in rel tion to wells, buildings, etc., can be-placed on reverse 'side). 'c - - - _T. FO DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- REVIEWED _-. � y ,- ---- ------------ DATE---- - ` - ------•---- REVIEWED BY------------------ -----•------- ---- DATE----- ------------------------ --•-----------------•--------------------------------- UILDING PERMIT ISSUED-.. .- ;------ -- ------ ------ DATE-----------------------AI#era+ions and/or recommendations:_,----- �LYS_ Z-1 c-r L �ver � J� _ f _ . '� - ---- --- ---- �- �------� `�-. -1;31t -�- -7 =�-`-5 -'-•- = �� -e-11:1 `-�`--�_. r - `_ <21.- �va:-'ne�� - �,a_A'.�� .ems-r� e - f, -- �`------ ---�P-�-`-=---------------•---s-"-"�----------_�-----P - � f x r. * � ---=- - ------ -=-----e........ .------=_- - ?<=��a—�'. `---_7 IV ` �� f rwz��t-.-� a - r—� - - le^ r s— ��.., FINAL INSPECTION BY: ---" .. _ ete ------------ - - -------------c-g---------------- JOAQUIN LOCAL HEALTH DISTRICT- 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Sfockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-6L9 3M 3•'63 F.P.CO, _,- /'.. • �