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R OFFICE USE: - --------------- � Permit No. -- ----�............. 7 _ APPLICATION FOR SANITATION PERMIT y/ �/ - ----------------- - -- ---------------------------- ------------------ -------- (Conlplete.in. Duplicate) Date Issued - ` Iv -----------------____-------- This Permit Expires 1 Year From Date Issued I Application is hereby made 4o 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 o. 549. 1 JOB ADDRESS AND LOC 0N._�e '"_ �f! ---__ - ; ------------ T - ---x---------`--••-�------•------------------•-------- + Owner's Name '� --------- --- ---------- -- --------------= Phone.-.'2 -- Address------- - f -------------------- ''=----------•--=---•----•- ---.....------------ Contractor's Name-------- � -- 6-----------------------------------------�' ``111"one..------------•_--_..--••-------•- Installation will serve: Residence ❑ Apartment House commercial ❑ Trailer Court ❑ Mofiel ❑ Other ❑'', p � � ✓ i ` 1 Number of living its:- . Number cf-bedrooms`:_ ____ Number of-baths _s�_,Lo# size- .- !-. -•------- - Wafer Supply: Public system'Community system ❑--Privat6_❑.._ Depth-oto Water Table ft.F Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cly Loam ❑ Clay ❑j Adobe [g- Rardpan ❑ Previous Application Made:-(If yes,date --:- �)^No �-Ne`w Constructon: Yes ❑ •No &g— FHA/VA: Yes ❑ No P-- TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is-available within 200 feet.) S�tic dank: Y Distance from n _______Distance from foundation-------------------.Material- _I____...._-____.______._ --------- ._.. F s q p. ..� ! i No. of compartments---------- f-- ---- Size-------••------------ ----------Liquid de th--------- ' ' Capacity Disposal-Field �, each line___.____'----.- 4 Distance to nearest lot line________________ Distance from nearest well____.._''._':.__. _Distance from foundation.._____"____. 'Ot! Number of lines----------------------- --Length of ea Width of trench-------------.------- - r Type of filter mater'ial--------------------------Depth oUj te.r material_'-------------1-----Total length_---.----------.-_----------`------------- Seepage Pit: Distance to nearest well__----:-________Distanee from foundation--- Za---_.___.Distance fp nearest lot line.-- ----------- r . fz i `i 1 Number of pits-----/------_-------Lining material_.__ Q -Size: Diameter__ ..._ `_,Deptn_� _...___--j,______._____. ICesspool: i Distance from nearest well-----------------Distance from foundation____________________Lining mate`nal__.________.__________ _______.__•__. J c ❑ Size: Diameter------ ------------_------ ----SDe th_---------------------------------------------------Liquid Capacity- ------------------- --------------- --- ❑ ---- ---------------------------------------------------- ------------- I Distance to nearest.lot Ione._____--------------------------------------------- ---------- ------------------- # Remodeling and/or repairing (describe]: 1- GuL `� w � ..--•-------------------- f it - ---------------------------------------- ----------- ---------------------- a -------- -----------------•----------_.----------------------------'----- -4_.._ t --------- `- 01 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Caun ordinances, State claws, and rules and regulations of the San-Joaquin Local Health District. � r _ ._ - _GL/v= r-=----- ------=----=--- -- - --------------------- (Signed) /or Co fractorl ----- -- ---------- - -------------- - i _ Title) G ''t . -� - -i------------- [Plot plan, showing size of lot, location of system.in relat' to wells, buildings, etc., can be placed on reverse side]. 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY1` =-----•----- - - DATE---------- �� ri REVIEWED BY--------------------------- -- r ----- ------ BUILDING -- k :._ RATE BUILDING PERMIT ISSUED-_---------------------------- ' =------------------------ - ------ DATE-----------------------------------„------------------ Alterations and/or rec9mmendVtiion_s:--------- ______ /- ---- ---- -------; L-/ —` ` -•--- -c- =�'-- ��/ _( -------------- - r ------- - `= F;-. --------- --------- ---------------------------- --------------------- -- .. I -------------- , = -------------------•--------- ----•--------------------------- ----------- ----------------- --------------- ....... -------------------------------------- ----------------------- ------------------------- ------------------------------•--------------- FINAL INSPECTION BY . L '�-' --------------- Date_.----� -------�----------- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Huxeltan Ave. 300 West Oak Street , 124 Sycamore Street, 205 West 9th Strea Stockton,California �. L di,;California `1\ ., " o nil Manteca,Calif , Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.CO. "F5