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ICE USE: ' " " - - _i.�_k.l___�_ _:_0_j___ APPLICATION FOR SANITATION PERMIT Permit No. ..r..'J_._._.__3.._ ------------------------------------------�'-`---`----- (Complete in Duplicate) —l� ! ._ Date issued --- ----`"-...�... f ___...__________________________ --__._______.___ ' ' This Permit Expires] Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. / f'� JOB ADDRESS A LOCATION ---- - _ l,� -.- �-� ALL ------- ----.- Owner's ! Y -------------------------------- -------------- Phone / _.t. ` F Name---- Address• '`--------- '%ice-k -��c_ .-............................................. Contractor's Name------ '1 ... ....R------ - .._.... '!-= 4-----... ' installation will serve: Residence ( , Apartment House ❑ Commercial E] Trailer Court E] Motel 11Other Eli i ``� _ Number of living units: ___/._. Number of bedrooms -,2- Number of baths !_' ---- --------------- Water Supply: Public system ❑ -Community system ❑ Private [g 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 ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t` (No septic tank or cesspool permitted if public sewer is availa6le within 2.00 feet.) Y 12 Septic Tank: Distance from-nearest well___ __________ Distanj i from foundation.___-----------Material__o_________ __ __A_s�____.__. No. of eom artments_ _ _____.____Size__ _7- _�v__Li uid de th__ � ��Ca acit _____ ❑ p ,T. ----- - � - q _ p. -- p y.... - 11 Disposal Field: Distance from nsare t well.. ____Distance from foundat'on._ ...�Z_:�....-.Distance to nearest t lin,/(-9________ 3. r Number of lines_____ Length of each line--6-0 =`_ .W�dth of trench._ _ ..., ------------- Type of-filter material.•--- _Depth of filter material____� __r____.Total length____ ____�_______________________ See❑ap 9 �'� Number of its____µ_______________Linin material-----------------------Size: Diamete ___x;-�_�'' .____.De th_. �_._..______�� a Pit: Distance tonearestwell____.:_•-_._-__ Distanc_e.from foundation.............:.....Distce to nearest-lotline______________:__ Cesspool: Distance from nearest well____._._-___..._Distance from foundation_------:___._..Lining material________________________________ _. ❑ Size: Diameter Depth _ iqui�[ Capacity gals{ ❑ --------------------------------------------------- -- - . fePrivy: Distance from kearest well-_____._______________________ _--- ---Distance from A arst building_.-----------------------------___._.____-- Distance to nearest lot line-_.------ ---_----------------------------------•..--------------------------r --------- - •------------- d\ ------------------------- Remodeling ----- -----------------Remodeling and/or repairing (describe) -:::_..* .._..... .----•--•------------------- y. y nA. 4 ---------------------'------------------------------------•----------•--•---•---------------------------------------------------9---•-----•-------- -- ll ------ ----------------------------------------------------------- -------- -------- --------•---------- ---------------------------- ------ 1 hereby certify that I have prepareditliis application .and that the work will be done in accordance with San Joaquin County ordinances, St a fa s, and 'r and�reg6lations of the San Joaquin Local Health District 1 d -- (Signed)... fa~. '----- --------------------------------------- ------- --r•----------- -- -Owner and/or Contractor By:--------------------------- ------------ -------------- ---------- ---------------------.....-------------------------------(Title)--------------------------------------- - - - -------------- (Plot plan, showing size of lot;'loca`fion of system in relation to wells, 6uildings, etc., can bel placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----= ...... •S --------------------------------------- DATE--- ---------------------- REVIEWED ---------------REVIEWED BY-------------------------------.__L------------------------------------------------------------------------------------------ DATE---1---------------------------` 1 ... BUILDING PERMIT ISSUED------------#--------- DATE - ------ Alterations and/or recommendations:------------------- -_.. .. ---------------------------------- • ------------J-•------•------------- ' -------------------------------•--------------------•----------------- •-------- ------------------•------------------------------.---•---------------------------------------•----------.---• •-- ----------------� =-----------• •---- ---------------------- --------------- ----;�------------- ---- ----------------------------- 1 I r ----------------------•------f - •- 1 �! -- - I FINAL INSPECTION BY: _a_': ---------- --------------------- Date---- - ---(9-A------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California 1 Lodi,California Manteca,California Tracy,California E9.9 REVISED 9.59 F.P.DD,3M 6.60 i� 1