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j FOR OFFICE USE: ! APPLICATION FOR SANITATION PERMIT Permit No. ---------------------- ___ .la •�_ --:-- - I-- (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 install }die wok herescrbed. This application i� •s matte in cc8pliance with County Ordinance No. 549. r 1- ��2 �Zi LG JO ADDRESS AND LOCATION_ __ _ ` ." ____ _________ _ _[ _ - /� G Owner's,Name--- 1 - !'.. ` = � Phone z� Address f ------------ ------------ --- ---- f =` -k------------- - ----- ----------- _ = ------ -- -� i Contractors Name-.--.,ZE _: --- ------------ ------•`--------- --------------' — . ---• . one Installation will serve: Residence Apart/ent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:= ---_}__ Number of bedrooms _;r Number of baths [-_ Lot,size ______________ _ ________________--_.----_--_---___.-- Water Supply: Public system ❑ Community system ❑ Private Depth to WaterTable;_��) ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy `Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: '11[lf yes,date--------------------) No [ New Construction: Yes o ❑ FHANA: Yes ❑ No t 6 TYPE OF INSTALLATION AND SPECIFICATIONS: (Noseptictank or cesspool permitted if public sewer is available within 200 feet.) Se t* from nearest well.... Ristan 'from f undati_.n------- __.Mateal '/ G fi7� �_____________� i �p No. of compartments--�� Sizes'. _!--��_ i—id de th____.___-._. / Ca acif / CJ I l q P. P Yf r = Disposal Field: Distance 'from neat well --- Distance from foundation =stance to nearest lot line_ ' - Number of lines................._------- .----.-Length of each line ___-'________?_ !__.__.V dth of french ___-a ...._........___._ I Type filter material_—_�. .____-= De th of,filter material_____ ___ __ _ �5 fir= y�p 9-It..--.Total length----- -�= T e off ` Seepage Pit: Disfabe n _ _ _ cejo nearest well from foundation--------------------Distance to.nearest lot line................. ❑ of pits----------------------Lining material-------- ------ Size: Diameter------------------------Depth...... p ---------------------- CessPool: pa nearest well----------------- from foundation --------------- material--------------.---_._---.___--_-_-_leDiameter - DI ----Liquid Capacity----------------------------gal s. L H wmiR R .kris Privy: Distance,from_nearest well -,--_ ------------------- -- Distance frc5m nEarest'building ------------------------------- ❑ Distance';to nearest lot line----------------------------------------------------------------------- ----------------------------------------------•------------ ------ g / re a Remodeling and/or irin,` (describe):-------------------------------- --•--- -•------------ ------=-------------------------------------------- --------------- I � l k p g - ------ -------------------------------------- ----------------+-------•-••----------------------•------------------------------------ ---:--------------- -----------------------------•------------------------------------------------•--•----`----•------ ------------------------------------------------- a ( -- ----- - -� ;------ ---•---------------------------------•--------------•-------------------------------- ----•------------------------------------------------------- -.-..---- --------- ! 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) �_ ---/Z---------------------------------------------------------------------- -------(Owner and/or Contractor) w' I-- - ----------------------------------------------- :---- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,,can,be placed on reverse side). •- a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED..'BY-------------------------------------------------------------------------------------------------- DATE-__,---------------------------- ---------------------- REVIEWEDBY----------------------- ---------------------------------------------------------------- E- DATEv----------------------------_------------------------- i BUILDING PERMIT ISSUED-11--------------------------------------------------------------------------------- ' = DATE-----J---------------------------------------------------- Alterations and/or recommendations: - ` = -- - �s-------------------------------------------------------------- ---------------------------- ----------------------------- ------------/V:`-- =----------------------•----------------------------=---------- -----------------'T------ --------------------------------- ----------------- -------------------- ---------=-------------------•--"----=------------------------------------------"--•--."- ----------------------------------------------------------------- ------ il , ----- ----------------------------------------------------------------- -- --- ------------------------ ^---•-•--------------------------------------------------------------------- ------------------- ----------------- - FINAL INSPECTION BY:xi--- -' Date cf - -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton 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.CM 11