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rUK U"K_t USE: ------- y --------- ------------ --------- -------- > _.fir_------ __. APPLICATION FOR SANITATION PERMIT Permit -No. _1_9 - �- ----- -------- (Complete in Duplicate) 1 This Permit Ex fres 1 Year From Date Issued ---•----- - --- ---- ----------- -- - Dafe Issued'- t Application is hereby made to the San Joaquin Local7Health District for.',a permit to construct and install the work herein described. This application is made4in compliance with County Or8inan'ce 549. x JOB ADDRESS AND ,LOCATIO f�1 -•-------- Owner's s{ f h ------------ -------------- Po Address-__--------------- le,� ,. 1 . Contractor's Name--- "es �_ ( -----------------y ----------- Phone------------- ----------•---------- -� Installation will serve: Residence A artment House Commercial ` ❑ ,t❑ Trail r Caurt ❑ Motegl-0Cher ❑ Number of living units:.__'__-- Number of bedrooms �__Number.-of=ba#hs- Lot size ___67�_- -- .__ - Water Supply: Public^.system Pp Y ❑ ' Community system ❑ Private ;De th�o Water Table _______ ft. i. ❑ �,. p Character of soil to a'depth of 3 feet: .Sand ❑!,Gravel Sand Lo m Clay Loam Clay E f � `r �, {:1 ❑ Y ❑ y ❑ Adobe Hardpan ❑ Previous Application Mader {If yes,dafe____________________) No ❑ New Construction: Yes �/No e ® ❑ FHA/VA; Yes ❑ �No �— TYPE OF INSTAL_LATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is.avatlable within 200 feet.) - // Distance f5om foundation-_.L1Q___ P { Septic T Distance from nearest well----- _ _ Mater I t---------C---_-- =------------ _ p t Size �' -- No. of compartments_ � �-��ff Liqurd d�pth------'�---------------Capacity---- Dis osal id: Distance from nearest well_ d----_-_,Distance from foundation_- f to ��__- Distance to nearest lot line _`45 _._____ -/Number of lines------- _ _-- _ Len th of each line______-__ __ k ll� 9 ----------7.6__ Width of trench -- " Type of filter material�� ?�`f1C[ [_Depth"of..filter materiaL___._,��___ Total length_�__.._.1� � - �] i { }} Seepage t: L; Distance to nearest.w II_.__IQ¢-._.___Distance from fou dation___!'i�_---------Distance to nearest lot line_ _ ?/Number of pits-------- Linin materlal �, fro`___ Size: Diameter_._-__ " 3 9 3_ _...___Depth---- ��`------- : i t Cesspool: i]stancb from nearest well_________________Distance from foundation---___;._____.___..Lining material.._.__._..___._____._-___________. ❑ Size: D-iameter_________ ____ _Depth `=` � f t*.: L;qu,d Capacity----- --gals. Privy: crest well__!----------------------------------- -----l.Dista'nce from nearest building- ---------------------__-_-- Priv Distance from ne ❑ Distance to nearest lot line - ` ----------------------------------------- Remodeling and/or repairing (de`se,ihe).:---------- 11. r - ____ 't .rc -�_ - i Y __ -------------------------- -- -------•------------------------------ = =' ---------------- I hereby certify that I have prepared t- aQplication and that_ the v�;ork will be done in accordance with San Joaquin County ordinances, State laws, and.rule's-and:;�egulations of the San Joa in Local Health District. (Signed)------------- ------ = Lf� "t = ' u, -- " -- ----------- ----------------------------------------------------------------(Ow net and/or Contractor) 8Y: ------------------=-•---`---------•---------------- {Tit o pan,.showing.size.of.lot,.location of s m in relation.to�wells, buildings, etc., can be placed on reverse side).. I a ( FOR DEPARTMENT USE,ONLY APPLICATION ACCEPTED BY----._.•-- ---------- DATE_------_ +_ - ------------- -------------- ---------- 1, 0 i I; -------- REVIEWED BY ----------------------- - _---------- ___ DATE BUILDING PERMIT ISSUED--------------•----- - i DATE--------------- -.--. __--------- ---- - -- - ---------------------------- DATE - . _ _ A teratiorts and/or recommendatiorts�___-�.�-�-""`�"��; ``� .- _._..r_——_=��-�--�-�--�.��-------_-_-_�-• --------- - —: : f--------- --------------- ------------------------------- -----------------•-• ------••--------------------- ---------- -•--------------------------=---- ------- ------------------------------. ------------------------ ------ --------- .+ FINAL INSPECTION 8Y-------------------- '-- -- - - _ Date------�_-`�� - ----------------------------- f ................................... L SA JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.p.CD.