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FOR OFFICE SE: _________________________ -------------------- --------- APPLICATION Z"FOR SANITATION PERMIT Permit No. ----------- -------------------------- --------------- (Complete in Duplicate - Date Issued - ------- --=--------- ---��--�----�----.- -- This Permit Expires i Year From Date Issued Application is hereby made to the San Joa uin L co ai'Healfh7%t�ic for l q permst to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------- .,5.2- _ ------------------•--------------------------------------- Owner's Name--------- r4 w� ...r - - - --------- -------------------------------------------- Rhone.}71C?___�-0`[5-j'----- Addressww.c �-------•-------------------------------------------- ------------------------ --•-••---------•----------------•------= Contractor's Name GiAC -------4--- a+_. ------- . i.(1- -----------•----- Phone-- � Installation will serve: Residence Q'� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1--- Number of bedrooms --- -.Number of baths --- Lot size Water Supply: Public system El- Community system ❑ Private [G� Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam M' Clay E7 Adobe[-' Hardpan ❑ Previous Application Made: (If yes,date----------- -----1 No E�/ New Construction: Yes 0" No ❑ V FHA/VA: Yes E] No Er TYPE OF INSTALLATION AND SPECIFICATIONS: i r. Septic Tank. tank or cesspool if sewer is available wifhin 200 f Distance from nearest well_---5-0..---Distance from foundation---� et) � No septic No. of compartments--------�—______ --Size--, --X-�.___1� q__---Liquid depth------�__12L—---------Capacity---$0p--- C� % Disposal Field: Distance from nearest well..,Y-C�...._Distance from foundation-__.._.._..Distance to nearest lot line------:OO Number of lines---------_-.I- '-_1�__ Length of each line--------___�O..--..__..Width of trench---------------- .. o,_ --__-•-- �'"� Type of filter material____ -lY.�...Depth of filter material--__-:1.6"_.--.-Total length------------------.___7 as--_-_--__-_ Seepage Pit: Distance to nearest wellt-J_tJC�_j--_ Distance from f$undation_....._1-0.......Distance to nearest lot line.. }� Number of pits------i______________:Lining material-_ _.Size: Diameter_-_--33��_.:----Depth-------------a7-ss'.------- Cesspool: Distance from nearest well_________________Distance from foundation______--_._-------.Lining material_-_-_--___-_____._.-------_--____-_ ❑ Size: Diameter------------ = �4------De th-------------- p ----- ----- Liquid Capacity----------------------------gals. Privy: Distance from nearest well---- --------------._---_----------------_.Distance from nearest..building_____.----.___-----.----___---_---------. ❑ Distance to nearest lot liner.-----------------------------------------------------------=------- Remodeling and/or repairing (describe :---_ _ . �cc cam:--__e~t- _.--'--_- ---- wy Yr 1 _____________________________________________ ___________T __________-.-__.________.____.__________-___________-_----_--_-_-_________-___ ,'fs. - .. y,,.� --------------------------- =------- --------------------- -------------------------- --------------------------------------------_--------------- I hereby certify that I haveprepared this application and that the work will be done'in accordance with San Joaquin County ordinances, State laws, and rule' and r-gulations of the San Joaquin Local Health District. _ d } (Signed)------- ....... �..------...1 _-------- ---- - tip , -- ________________________-__._._O ner and/or Contractor) By: +' i --- ----- ----------- ' F • L+I (Title) �' -(Plot plan, showing size of lot,'location f system in relation to wells, buildings, etc., can be placed'on reverse side). c r . F FO DEPARTM T USE ONLY APPLICATION ACCE ..... - REVIEWED BY ------ ----------------------------- ------------------ -------------- ------------------------------------------------------ DATE E-----�--- - � --ccs.. __,,,� -- ---------------- BUILDING PERMIT:ISSUED --------------------------------------------------------- --- ---------------------------- DATE---------- Alterations enid/or recommendations-------------.-.---._ . t -------------------•------------------------------ •-- i ------- ------------- -------- --=---------------•------------------- d --------- -1--------------------------------------- --------- 1 FINAL INSPECTION B ---- ._ -.A + �Qtom# 1 Date_ ------r------�-------- --- ---------- -- - ------ ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,CatiFornin Lodi,California Manteca,California Tracy,California ES 9 REVISED 5-5$ 3M 3•'63 F.P.CD.