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` Ir1..0 USC: �_ - --- � APPLICATION FOR SANITATION PERMIT Permit No. .._._.. ------------ --------------------------------------- ` � - _ - l 7 1' kms, [Complete in Duplicate _ This.Permit.Ex fres.i Year From Date~Issued Date Issued __.(__--36 6 Application,is hereby-made-to the San Joaquih!Local'HeaJfh Distnctfor a permit to construct and install the work herein described. This application is made ir1 compliance, with County Ordinanc No 549. r t JOB ADDR LOCATIOIq.!. r�31 C1 i Owner's Name-:_ - . ---------------- ------------------------------- ----------- Phone, Address # ) ---------------------- --•----------------------- -- -- Contractor's Na'me_-._ .. /J r '-----•----------•-------------•--------•--•---------------- -- : ---- -----�------- e... __._�-_- �------ Installation will serve: Residence �Ap rtment House ❑ Commercial :, r ❑ Trailer Court 0 Motel ❑ Other ❑ Numberlof living units: __I-- - Number of bedrooms _4_-_ Number,of baths.__ Lot size __-/_ a`P--aC- f _ Water Supply: Public system ❑_ Community system ❑ Private �pth to Water Table t_ZQ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ �Cla y ❑ Adobe P ~" rdpan [] Previous Application Made: {If yes,date--------------------) No �New Construction: Yes [��o El FHA/VA: Yes [:1 No �--� TYPE OF INSTALLATION„A-,ND SPECIFICATIONS: (No septic tank=or cesspool permitted if public sewer is available within-200 feet.) I Septic Tank: Distance from nearest well_�2 -----__Distance from foundafp n__le t - , � Material___ v �� .�J'L € No. of compartments_- __ cSf . S�ze_a -_ g- _-- _L,Liquid de th._-- i° - q �p : - - --- Capacity- 1 fir' Disposal Reid: Distance from nearest well__-_15" -------Distance from foundation_h�--_.------_Distance to nearest lot line__ -�_---" Number of lines__---2-___ ---- --------------Length of each line___ � 5-3 !�of ", 9 �_. __-- --- Width of trench- ------------- --- --- r• Type:of filter materia-__ fi[__K- Tif -- ____-___. x Depth of,filter matenal___. n_..............Total length____IQc7 to Seepa a Pit: Nlumberaf nitarest well_ . ---_-g_""_Distance rom foundation -_" Distance to nearest lot line_-_ r i p --------------Linin ma#ena------r[.-�(.... --._-_ - Y'/ ------- Diameter W Depth - CesspooL• Distance from nearest well____,-----_--}Distance from foundation.--------------- • _linin material------------------ El _- Size: Diameter.----i t g -------- --. - -----� �---:Depth---------------------------• - ------ ---Liquid Capacity--..-- Priv '' i -- -------gals. i Y ' Distance'from nearest well--- -------- :..Distance,from.near rest building ~Zf -- -----= ------------------' ❑ Distance to nearest lot line---------- =---- { g _ --------- ' {{ --------------------------- Remodeling and/or repairing (describe):-----------f(�Ps ------- - — -------------------------------------------------- /.' � __ -- -- - L_ ' -_ _"' ---�-`-� `7` 'mai- -�C7� -- - ------ --- --•------•----- ,r - -t �, --------------------- � ____________________________ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and .regulations of the San;Joaquin Local Health District: 1 �y f t (Signed)------------- c1J # ----------•-- -------------- 9y-----------------•- � ' � (Owner and/or ntrac d/o Co tor) A ---------------------------------------(rtle)__J.0-- - --- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). l' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - r REVIEWED BY 7 - DATE � ` _ - - DATE UILDING PERMIT ISSUED -=-------- --------------------------- DATE - Alterations and/or recommendations:._._ �l 1` , .� - .� r - --------------------------- . f -------------------------- I / ------ ---------- -- k ---------- ------------------------------------------- 1 •---- ------------------------------------ •----•--- ----- t - Y - ----- --------- FIAr-INSP'ECTION'.BY:_ -' �.�� --� . - -f---- --- --------- - Date---- +� --------------------- AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naselton Ave. 3 0 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California ES 9 REVISED 8-59 3M 3•'63 F.p-C O. Tracy,California r