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FOR OFFICE USE: -------------------------------------------------------- ------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ..r... ��$... ---------a----------------------------------------------- (Complete in Duplicate) ,/� ' � Date Issued ._7_ __�Z__b � - ----------------------------------------------- -----_ This Permit.Ex ires_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. 2��0,�'..:,-.E Zb, �l— 3�0—mss JOB ADDRESS AND LOCATIONP ------ �� . '' i'1 �K�.1�. ------------------------ Owner's Name-----------•---• � �+ �s -�G--------------- •------....E--------------------------------------------------------------- Phone------------------------------------ Address-----------------------------------t ----•--- =; Contractor's Name 1` ! r `- Le_�i`��_ v - Phone.. .......... • • Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other Number of living units: _______ Number of bedrooms ________ Number of baths -------- Lot size --------�i_O____A_C'721'1-5-_____`_-______---•`� Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ________ ft. Character-of soil to a depth of 3 feet: Sand ❑ Gravel ❑ . Sandy Loam ❑ Clay Loam ❑, Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes-Z No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: N (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well------G-Q'/_Distance from foundation.-_AP---------Material____-_ MXNo. of compartments------ --•--6----------Size---------------------------------Liquid depth--------------------- ----Capacity-••-------------------- tp;Rrsposa Field: Distance from nearest well....... Distance from foundation._ig-0--- ...Distance to nearest lot line------s!__f___ Number of lines----------------- -_ Length •., Len th of each line______ --------Width of trench-------------?--- ----I----------- Type ----------T e df filter material__-- Depth .of filter material d ___Total len th___________ _-°7->_-- s Seepage.Pit: Distance to nearest well_____/_,�___._-Distance from f undation___-_eQi_.-._-_.Distance to nearest bot line____„1�_____._ Number of pits_____.__./________::_Lining material_____-Size: Diameter____`O•.`...____Depth__---_-_-�,�y._--________ �(? Cesspool: Distance from nearest well __________------Distance from foundation---.----------------Lining material------------------- -________________- ❑ Size: Diameter--------4_-------------------------- Depth-------------------•-----------=--------------------Liquid Capacity----------------------------gals. , Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____-_________________-_-_________--_. ❑ Distance to nearest lof line--------------------------------------------- ----------------------------------------------- ------ Remodeling ----Remodeling an or repairin (d sc ibe):--- ---_ --- Qf- -. � -- � - �� ---------------------------------------------------- o. �. ---------- --------------- d - - 1 hereby certify th h ve pre red this ap icafi and that the work will be done in accorance wi San Joaquin County ordinances, State I s nd r re tions of the San Joaquin Local Health District, (Signed)--- -f -- - - - -- ----------------------------------------------------------------------------=-------------------------------(Owner and/or Contractor) By: _(Title)_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). •. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------- ----------------------------------------- DATE-------- ----- sREVIEWED BY------------------------------------------------------ -------------------• ---------------------------------------------- DATE BUILDING PERMIT ISSUED------------------- ------ - - -------------------------------------- DATE._ -------- ----------- Alterations and/or re m endatia s:_____ 6 _/— W -�we4 ,e ! -etr __ 4t-�g�....--------------------------- ----- - ......... fr � ----e&------ --------•------------------------------ -- ------------------------------------ ------.-- .--- - - ------------------------------------------ - ---------------- ------------------------- -----I----------------------- ----------------------------------------------- FINAL INSPECTION BY _ - - Date--- (P r-_ 6---Z' AN JO AQUIN LOCAL HEALTKDISTRRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES•9 REVISED 9.59 F.F.CC2M B-6D ~