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- S6# APPLiCATION FOR SANITATION PERMIT Permit No. ._..,/�2..��3 --------------------------------------------------------- (Complete in Duplicate) 11 _ ., .. .v - ---------- --------------------- ; This Permit Expires T Year From Date .issued date issued Application is hereby made to the San Joaquin Local Healfh District for a permit to const uct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION___ 7�_ aA/� -7--f-W l ' Owner's Name------------•---•- �: ---------•------- •---------------------T----•------.n----•------------------------------ •-------•---------•------------•--- Address S ......---- = s ------------- Phone.. •--------------•--•-•--- Contractor's Name---- -- --•- •----------•---------------•-------- -- •---•- ---- r------------------•------- '- --•------- ---- Phone. installation will serve: Residence [r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel L] Other ❑ Number of living uni#s: ___r-__ Number of bedrooms __`�� Number of baths _____ Lot size --- Water _6 r Water Supply: Public system 01�_Community system (] Private ❑ Depth to Wafer Table _Zpft. k Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑F Sandy Loam ElClay Loam ❑ Clay ❑ Adobe Hardpan E] Previous Application Made: (If yes,date--------_-----------) No New Construction: Yes [�No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: \ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Y Septic Tank: Distance from nearest well --------------Distance from foundation_/4_r-__ V-- Material_ _ \ No. of compartments____;Z,,___ ---------size----- _ _-•-Liquid depth____ cra -- ---------- Capacity_.. Disposal Field: Distance from nearest weil____ ____..._Distance from foundation_,( I__- -_-.+Distance to nearest lot line__�__�____.. Number of lines_,..___________________________Length of each line_"--_4_1_43-'Width of trench___ 4_"--__--_- --------- --------------- --_ _ Type of filter materia__F-01-(AC_.______ YpQepth of filter.material___fg'_�--_-_----_Total length----�j'r_.a------------- Seepage Pit: Distance to nearest well_r_- -------Distance from foundat.ion--]B__ �`-.Distance fo nearest I line_�cs..��_ EV Number oft pits---i-------------------Lin material 4L _'""!Size€3ia'rriefier33-`___----------------Depth_.-- -------------- Cesspool: Distance front nearest well------------ Distance from foundation_______ ._____.Lining material____.______._____________:.___-_____. t ! r 4 F 1 ❑ Size: Qiameter ------ -------------- -------"� �t Depth Liquid Capacity --------------------------gals. Priv i 1 - d � i4, • Y= Distance from nearest well-- ----------------------------------------Distance from nearest.building ----------- ❑ Distance to nearest lot line__.__.__._-___-_ -- -------------------------- Remodeling and/or repairing (describe)__________________,-� -s_ i ------t-----• -------------------•- - -------------------- i ---- --- -------------------------------------------••-•---------=--- ------------------------------••---------------------••-------------------- I hereby certify that I have prepared fh'is application and that fhe,work will be done-in accordance with San Joaquin County ordinances, State laws, and rules and regul ion of the San J-oaquin Local Health District. (Signed)-,------------------------ ---------------------------- # ° ___--_-_-----.(Owner and/or Contractor) ------------------------------------ BY:------------------------- -•---- i ----- ••------------------- ------(Title)--------------------------------------------- -------- -------- (Plot plan, showing-size of lot, location of system i relation to wells, buildings,.etc., can be placed on reverse side). - i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ �� _—s' -------_---- -------------- DATE----�_-.� _-_(e` REVIEWEDBY---------------------------------------------------------------- DATE - ------------ r ---------------------------------------------------------- BUiLDING PERMIT ISSUED------------------------------------------------------ ------ DATE-------------------- - -- ---------•------ ,- Ateratitsns and/or recommendations � � - ------------------------------------------------------•-------•------•----------- ----•-----•------•-----•---- FINAL INSPECTION BY:.___�.-�_-- - 5----------------------------- Date-- --i.6---- 9 {Q�------ ----- ----------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 I;.Mozelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California £5 9 REVISED 8-59 3M 3-'63 F.P.Cd.