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FOR OFFICE USE: /y, a u APPLICATION FOR SANITATION PERMIT Permit No. ....fG.v-�- 1p�9 Gv-------'------------i�------- -------- (Complete in Duplicate) Date Issued 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. JOB ADDRESS AND LOCATION---94� - --V ------`----- ,------- Owner's Name---/724-1---Xt-_?V---- �- - ---- ---.-. Phone------------------------------------ Address--------------------- G --------------••------------------------------------------------------------------•--------•---------------------------•------------------------------------ Contractor's Name--------- -'-----...1,4 e---•----• -------------------------••------------••---------------------- Phone-4W--15-7 Installation will serve: Residence I Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: ---I---- Number of bedrooms Number of baths ____-__ Lot size -10rO... Water Supply: Public system Community system [-IPrivate ❑ Depth to Water Table /� �c_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,dote__.--- .............I NoiPf New Construction: Yes ❑ No/K FHA/VA: Yes ❑ N/X TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) a Septic Tank - Distance from nearest well_________________Distance from foundation-------------------Material-._____________________---_---------.----.___. Liquid depth-----------------'--------Capacity---------------------- ❑ No. of compartments--------!-------------'--Size-------------------------------- Disposal Field:, Distance from nearest wO-_—. -Distance from foundation----t1�_.____.___Distance to nearest lot line---��,]_ -----.- �r Number of lines_____________ _ Length of each line________-_- -1----------- of trench_-___._____2-` _.__________._ �Q Type of filter 'Material--- Depth of filter materiaL______ Total length____________________��________.____ V Seepage Pit: . Distance to nearest well_'kl. .-Distance fro foundation---._f p_'_..___Distance to nearest lot line------------------ 00 x Number of pits--------I--_...__.__Lining material__S5:__k0�1�_._Size: Diameter--.-_-__33—-____.Depth__..__-__.-Zs' Cesspool: Distance from nearest well_'______________Distance from foundation--------------------Lining materia!-------------------------------------------------------------------LA ❑ Size: Diameter--------------------------------------Depth------------------_------------ --------- ----Liquid Capacity----------------------------gals Privy: Distance from nearest well_________________________..--------.--------,-._Distance from nearest building____._____.______________________._--. .� ❑ Distance to nearest lot line----------_-_'(--------:----------------------------------------------- 0 r Remodeling anti/or repairing {describe):----,A- �!'----- :� - ------Q ------------(5 7-Z � ----------------'----------------------------• 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 Joaquin Local Health District. (Signed)----------- --1yC' - -------------------------------------------------- -------------------------------------(Owner and/or Contractor) By:------------ ccp --------------------------------------------------------------(Title)----- — ----- -------- -------- ---- -------- (Plot plan, showing size of lot, IocatidFi of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --_ DATE--------L�7 f-_-- �✓�/-------------- REVIEWEDBY------------------------------------- -- ----- --------------- ----------------- ---•----------------------- DATE---------------------------------------------------------- BUILDING PERMIT ISSUED---------••----------------------------------- DATE------------------------------------------------------------- -- ration d/or recommendations: ��f 6.. -.. ----- �---•---•------------•---------------- ----- ----------------- �� " 6 -� - - - ----------- -------------------------------------------- --- ---' ------ .o -- � � FINAL INSPECTION BY:._ _ _ - - -- / _- Date-% - ---- ------ -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California CS 9 REVISEa 6-59 3M 3-'63 F.P.CO.