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FOR OFFICE USE: s ---- ---------- --------------------- �. --_---------- --------- APPLICATION "FOR SANITATION PERMIT Permit No. ___ --7/ '•2� ----------------------------- -----------W.:--------- -- (Complete in Duplicate) J Date Issued ---------- Iv -------------------------------------------- ------------- This Permit Expires 1 Year From Date Issued 9 r r Application is hereby made to the San Joaquin Local Health District for a permit to construct �d irsialfthe work herein described. This application is made in compliance with Cou ty rdinance No. 549. JOB-ADDRESS AND LOCATION1 y-eA---------------------- Owner's Name-----------------•--F`�" t---- ----- G - Phone_ Address t --•- _, - Conttactor's Name____.___---_________ w- K-le ---------------------------------- -- ---y-�•�--------------- ----------- - Phone-----------•.............---------• Installation will serve: Residence'�a"`Apa��ment House ❑ Commercial ❑ raper dee ]$� Motel ❑ Other ❑ I i Number of living units: _ ._._ mber of bedrooms -_/--_ f- Number of baths -- --- Lot size _�_ _ Water Supply: Public system Community system ❑ Private ❑ Depth t ater Table ----f__ ft. Character}of soil to a depth of 3 feet: Sand L] Gravel F1Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Ilfyes,date--------------__._} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION-AND-SPECIFICATIONS' - 1 (No septic tank or cesspool permitted if public sewer is available within 200-feet.) r �^7 -----•----Malt Ta -- _ �d--- - --_-- ------ Septic Tank: Distance from nearest well--- _�_____�_Distan �,fr rn-noun at}on>�l1- _ � � � {� No. of compartments----:---1�---_-.-___SiLiquid deze_ r__ _ __ ____ p.th__________ ___ - _._Capacity__4T d- e - if Disposal Field: Distance from nearest well___..-.-._'----Distance from foundation_ _ Q._�_.___;Distance to nearest Ijne-__ ._ / rNumber of lines----------- _______________ Length of each line---------�_t-__�j_.--.Width of trench._._____ j_ V) Type of filter material, � �-rA4j Depth of filter material___.__ Total length------------ fh_Q____________ '7 F 17 Seepage Pit: ✓ Distance-to.nearest well-.----------- ------Distance from foundation--__-_--___-_.___'Distance to-Inearest lot line----------------- P ❑ Number of pits--.'--_--,-:---- --'*;Lining material---------------------Siie: Diameter-----------------------:Depth--.------------------------------ _" _ . Cesspool: Distance'fiom 'nearest well_---_____.-w--- _'Distance from foundation _ Lining material_____________ ____.____..____.______. Size: Diameter---------------( ----------De th-------------------------------_ -�_Li uid Capacity -----------gals. Privy: y Distance from nearest well------------------------------------------------- from nearest building_l----..___----_-----_________..___.___._. y� ❑ Distance to nearest lot line --------------------------------------------------- = '--------------------------------------- 3�1 Remodeling and/or repairing (describe]__ _____________ QT _____-,Cl°f1 .4 - 1_lSt�----- RQ_41T----Q - - /4 . i ---------------------- -------------------•------ _--------------------------------------------------------------- 1 ------ E - _ :- - :- - -...:-- ------------- --------------------------------.-_:---------- 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 Joa uin Local Health District. [Signed) = a------------------------------------------ ------------- - (Owner and/or Contractor) y- B -----------•---.------- •-------------------------------------------------------------------------------------- -----•----- -----(Tif le)----------------- ---- - T-. (Plot plan, showing,size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). f 1 FOR DEPARTMENT USE ONnLY APPLICATION ACCEPTED BY.------•------- --------------- - ---------------------- ---------- --- - � -- / DATE----- REVIEWEDBY--------------------------------------------- --------- ----------- ---------- ---------------------- ------------------- DATE BUILDING PERMIT ISSUED - -------------------------- ------- --- ----------------- DATE------ ------------------------------------------------------ Alterations and/or recommends+ions:---------------------------------------------------------------------------------------- -------------------•-------- -- ------------------------------------ _i ------------------------------------ -- --- -- - ------ ------------------ ------ -------------------------- ------------------------ 4 II � 1 _ FINIALINSPECTIO ------------- ---- -- Date -------------------- ._. SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California a Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CD.