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FOR OFFICE USE: ------------' ; 3.:--33- 'L " -------------------------_---- -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...,/-. ' 7�. - ------------------------------------ ............ (Complete in Duplicate) - This Permit Expires I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------_:4:e4_� t Owner's Name ?a- -------------------------------------------=--------------------------- ---- - ------- Phone----------------------------------- i________ _____"-.-_---_----_---_.""- / _----------.------------------------------------------------------------------------------.___-"_"-"__--r_---.--_.»- Address__........ -7.--3 j---- Contractor's Name --------------------_-----------•------- ----- Installation ---Installation will serve: Residence o�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units:,./_._._ Number of bedrooms I---- Number of baths __/..-.- Lot size ----- d-X.-I-A-0........................ Water Supply: Public system P" Community system ❑ Private ❑ Depth to Water Table j:�?_rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe pr Hardpan ❑ Previous Application Made: (if'yes,date--------------------) No [t} New Construction; Yes A-- No ❑. FHA/VA: Yes ❑ No E!J-- 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-r,*—e_--.Distance from foundation--_ Material.__/R d.Wa _.1d___..__- ------- No. of compartments-------- --------------Size--- _`�•'_y__;tc_y'_ _Liquid depth-------7� -- ---_--.--Capacity_- Disposal Field: Distance from nearest welf_N4"-_.- - -Distance from found at ion__Zg" ..........Distance to nearest lot iine._a`--__--"_-_-- . Number of lines----____2-----------------------Length of each ...Width of trench....,Z.`__,__--.-..-------------- f Type of filter material___' _/k_____-Depth of filter material----/__�r_------r._.--.-Total length___."_1.3-4----------------- Seepage Pit: Distance to nearest well__1'��--------.---Distance from foundation---?�v.... .......Distance to nearest lot line__ .... ....... ; Q' Number of pits------ 2--___ Lining materiai__. _-.Size: Diameter__ ............Depth....Z-.r---"- ----" Cesspool: Distance from nearest well----------------- from foundation....................Lining material------_------ .-.-.-----_-._--_--_. ❑ Size: " eter---_...----__ .Liquid Capacity gals. -- ----------Depth--------- ------------------------------------------ q P Y- - ------------------------ Privy: Distance from nea ell._._"----."----------------------_------------__Distance from nearest building-.--------------------------------------- i Distance to nearest lot line------ . Remodeling and/or repairing (describe):------------------------------ -- ----- --------- ^---:--------------------------------- -------------------------------------------------------- � -------------------------------- -------=------------------------- -------------------------------- ------ -------------------------------------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. � `A�� (Signed) ------------------- ------ --- ----r te------------------- ------------------------------------------(Owner and/or Contractor) BY:------------- - ----- -- --------------------------------- - -------------- -------------------------------- ------(Title)---------------------------------------- - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY y APPLICATION ACCEPTED BY- = L ----------------------- -- - ---------------- DATE-- —7= �1 REV15WEDE�Y--------------------------------------------- ------ --------- ------------------------- DATE BUILDING PERMIT ISSUED---------------------------------------------------- - DAJFf Alterations and/or recommendations:__ .:7 �'--- '2 � �. ' ---------------- - --------------------- ---------------------------------------------------------------- ---------------------------- ---- ------------------------------------------------------------------------- -------------'-".._...__..._-------------------`--._-.-.-.__.._------' ---_.._...__._____._----------------------------------------------------`-"---------`---"_.._....r----------'t----------------`-- ............__---___-------_-----------------------------------------_.. _ __.___ ____ ._."._._"..._.-.""--.."....-.-.-.""".""--"".."_--.""-.._...-__.--..__.______._ "-""_".___.-.."-".---.--- .------.----- . FINAL INSPECTION BY:. ------------------------ Date. 7. � '- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street. Stockton,California Lad 1,California - Manteca,California Tracy,California F.P.r O. 1