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FpR OFFICE USE: � A/_� ---------- ` 3v APPLICATION FOR SANITATION PERMIT Permit No. 11_.3--.__. .z._/6---------------------- --- ---------------------------. �_ (Complete in Duplicate) Date Issued __//-�,&--v ---------------------------------------------._.._____._._ 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 the work herein described. This application is made in compliance with County.Ordinance No. 549. JOBADDRESS AND OC TION.. --------------- ----------- -----------:------------------------------------- Owner's ---------------------------------------------- Owner's Name----------' t !. - ---------- --- ---------------- Phone------------------------------------ Address ------- - - -- - -- -- ----- Contractor's Name-----.....� -----------------------------I-------------------- ---------------------------•Phone---_- .•-------_-•--------- Installation will serve: Residence *-X'partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -A-- Number of baths 1�___ Lot size jt `a_X_1 ---••-------------------•-------- i Water Supply: Public system Community system ❑ Private ❑ D pth to Water Table-&-ft. Character of soil to a depth of 3 feet: Sand L] Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay ❑ Adobeardpan I-] Previous Application Made:, (If yes date_.._--_--___.___) No ®�ew Construction: Yes g? AVO ❑ FHA/VA: Yes E-] No 1 1 . TYPE OF INSTALLATION AND.SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) s < Septic Tank: Distance from nearest weI -----Distan,ce//prn foundation__-la-__.__._.MatedI_el//✓- ----------- ®� No. of compartments._., ________________Size.,1_!Q.✓l�_ _ -_--Liquid depth__.��__�____._._..__-Capacity_r1pr .__._-_ Disposal Field: Distance from nearest well.. -------.-Distance from founda-ti 4----1�-------Distance to nearest lot linea01 ��-_...-- Number of lines____! _----.__ ____.-____-- Length of.each Iine___ �I-----------------Width of trench_ "____________________-___._ Type of filter materia —Depth of filter materiaL-At'o -._Total length--f 1 ------------------- ----------------- Seepage Pit: Distance to nearest well____---�-`._______Distance f- m foundation----��-./.___.Distance to nearest lot line__1._-f__1--_.__ (� Number of pits___ _ __Linin material_ ,,.-Size: Diameter-j,;�-#7......-=Depfly, / W�Z_t- Cesspool; Distance from nearest well_________________Distance from foundation-----------.-------.Lining material-------------------------------------. ❑ Size: Diameter--------------------- ----------------Depth---------- ----------------------- -----------------Liquid Capacity----------------------------gals- Privy: Distance from nearest well------------------------------------------------- from nearest building_____--_-_________-_.________------.----. ❑ Distance to nearest lot line-------------- ------ ---- -------------------•-------------- ---------------------- Remodeling and/or repairing {describe):------ �u � � - -----•----------------•----------•--"---------------- --------------------------------------------------------- ----- ----------------------------------------••-------•-------------------"--------.--------------•--------------------------------------------------------------------------------------------- -------------------------------------I----------------------- --------------------------------------------------------------------------•------- ----- -------------------------------- --------••-•--------------------------------------------------------•,--------------------------------------------- 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. ___{ �or Contractor) (Signed)------------------------ / By:----------------------------------------------------------------------------Pitteo -- ---- (Title) (Plot plan, showing size of loft, location of system in wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY • ,APPLICATION ACCEPTED BY--- 4 . --C--------- - ------------------------------------------------------- DATE-- -------------------------- -REVIEWED BY------------------------- ----------- --- --- ------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------- --------------------- - -------------------------------- D/�TE------------- Alterations and/or recommendations:_____ �f 2CJ _ -��c ------ j"------------------------------------------ ----- -------------- ' .-- - ---------- -; _ 5 =-fig `" -7 ------ - -- ----- ---------------------------- = 1 ---------------•----------------------------------------------- --- - --------------------- ----------- -----------t ------------------------ -------------- ---------------------------- ----------------- ----------------------------------- ✓ � S FINAL INSPECTfON B.Y ---- _ Date--------------------------------- ------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT. "x 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockfan,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3-'63 r.P.CO.