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FOR OFFICE USE: _____________ _.-__---__-_--------.�- APPLICATION FOR -SANITATION PERMIT Permit No. r 31--� -------------------I------- ----------------- -------- m - . . ._� . (Complete in Duplicate) _ x-�- - T-, _.. . Da+q Issued I----------3 -___7 _______________________..--_.-__.._.__---_..__.-__..__. This Permit Expires 1 Year From Date Issued .} W Application is hereby made to the San Joaquin Local Health District for a permit to construct and install +he work herein described. This application is made in compliance with County Ordinance No. S49. i JOB ADDRESS AND LOCATION_.�pa/.--- . .CJ? 7 X41 ------------------------------------------------ r Owner's Name _ f7L. a �� ---- = ._.-- ., Phone.__.---------- I Address------- -------------------------------- ---------------------------------------=------ -----•----------------••----------------..---------------------------------------------- Contractor's -------•--------------------------- ------Contractor's Name-----:- _/L -;.e0k 9-/_V__. ---------------------------------------------------------------------------------- Phone--------------••------------------ Installation will serve: Residence [YApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: _1__ Number of bedrooms__ Number of baths .Lot-size li-Z& O _-------------__________-______ f Water Supply: Public system ❑ Community system ❑ Private @?'Ibepth to Water Tabled5i�9_ft. �* Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ V Previous Application Made: (If yes,date--------------------} No WEr"o New Construction: Yes g?"No ❑ FHA/VA: Yes Zj-- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available.within 200 feet.) - - a J Septic Tank: Distance from nearest well-_-eD-______Distance from foundation__ 0_______._Materia/` _ ________________ No. of compartments'--A------------------size xl_- --------�� __Liquid depth_-$��-------------Capacifyf x,*?-___- Disposal Field: Distance from nearest well-�t. - Distance from foundation__,eoo __ __..Distance to nearest lot Number of lines_____A____- Length of each line__f �� o Width of +rench ---•--f- ------------------ Type of filter materiaf �Depth of.filter material__ _,______„Total length_ :________________________ Seepage Pit: Distance to nearest well-0-law- _Distance fr mfoundation_,____.-_.Dist Jce to nearest lot I�ea .__ Number of pits--.-I--------------Lining mat erial�� .Size: Diameter__,R, ._____..-__Dep+hr±��"'-_/_ { Cesspool: Distance from nearest well-----------------Distance from foundation___________________lining material-------------------------------.______- Size: Diameter---------------- Depth------ ------ --------- ----Liquid Capacity ---gals. Privy: Distance.from nearest,well-------------------------------------------------Distance from nearest.building------: _,___.::_____________._.__.__-- ❑ Distance to nearest lot line_ ------- ------ ------ - -------- ----------------,-�-- -------------------------------------------------------- ------------- Remodeling and/or repairing (describe]:------- ---_---• -_--_-___--•-__-•_•-__------_-•__________________________________________________________________________________________________________ �y _____________________________________________________________________________---.--___._____________________________________--_______--___________-__________.____________.____ ---- ---------------------_---------------- __..________-__________-____a______________________.._--___-_________-___________________-----___-_-------_------_--_-___.----______._-________________.___.___.____________________...__._ 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} 6 - ------=------------ --- �/or Contractor) BY:------------------------------------------------------------------- -u .(Title)--- ii//. --------------- --- ................ plan, showing size of to+,;location of.sys+em in re n to wells,.buildings, a+c.,,cen be.placed on reverse side). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B - ,�- ----------- DATE_/� `.-_A .7 REVIEWEDBY---------------------- - ------ DATE------- ------------------------------------------------ - BUILDING PERMIT ISSUED------------- ----------------------------- ---------------------------------------------- DATE---------------•-------------------------------------------- Alterations and/or recommendations:--------- --- ------ ----------------------- '------------------------------------------------------------•----------------•---•------------------ ----------------------------------------------------- ---------- -------- ------ ------------------------------------------------------- ------------------------•----------------------------------- ------------------------------------------ -------------------------------------------------- FINAL INSPECTION BY: Date-- ��'r�1 `1v 7------------------------------------------------ '• SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISCD 8-59 3M 3-'b3 F.RCC. f