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FOR OFFICE USE; r" - ------------ ------------- Y ��------------ ----------- ------------- _.__....._--- APPLICATION FOR SANITATION PERMIT Permit No. �.7___' .. ------- ------- -- --- ----- ----------- ----------------- - (Complete in Duplicate) ------------------ This Permit Expires 1 Year From Date Issued 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 d !�,--.- "_". --------•-------------------------- Owner's Name----- .(d a/Ifl_C :_--`_ . G� qJS--- --------------------------- ------- ---- Phone Address.- -e�, ? c� �; L�[.� ; {� P -----------------------•--------•-------•----••--••- Contractor's Name --------- Q.( -='-'u ----------------------------------------- Phone--------------------------------- Installation ------- Installation will serve: Residences® Apartment Douse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __. lu of bedrooms"---Z Number of baths ' Lot size ---- 1_®_., (._/..a- ----------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table.'?it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan [] Previous Application Made: (If yes,date._..--_.--'.-------- `No Er New Construction.: Yes ❑ No A/VA: Yes ❑ No E�— TYPE-OF INSTALLATION AND SPECIFICATIONS: f (No septic tank orcesspool peirriitted°if public sewer is available within 200-feet.) -- `'a t `f _.. _.. Septic Tank: Distance from nearest well--------- ------Distance frorri foundafion.__:_--____-1r-_----Material"----- =----- --�_- f�/�� r_N -of-compartments- ----------------------Size-------------f---------------.Liquid depth---------------------- Capacity--------------- - ---- Dis osal F' Distance from nearest well---_._..:._._.._Distance from foundation---1. --- Distance to nearest lotline--_�f_-- p -_ Len `fh'of each line_....- ._A_-_. .�--.Width of trench__.c�... --_ Number of lines.__._ .__....I � � of filter.,material / ' De th of"filter material--__ ___ __/___---Total length- 0 '^ �'�t [7 / 4 Ary Seepage it: i{ Distance to'nearest well.._--__Distance rom foundation.. Y ..Distance to nearest lot line--. .`--_ Number of pits.__ ' t ---------sLining material__ _C.k l..Size: Diameter. _ _f_. --Depth-,. R Jam` r CesspoaV Distance from nearest well-----------------Distance from foundation--------------------Lining ❑ ! Diameter material_- --_--.-_-------------------_------. Size: --- ---------- ---�--------------Depth4t .-:------ --=------------------ ---------------Li Liquid Capacity------------_---------------gals. Privy: _ ? -Distance-from nearest-well--�.�-:--__._.__-____- �_--------------_Distance 4rom-nearest builcling�-__-- --_�.-_--_. } ❑. Distance to nearest lot line ----- ------•----------------------------------------------------=--------------•---------------------_ 4' Remodeling and/or repairing Idescribe):------- -------------- ; -_-----------_---_--_---_-_- ------•----------•.....-•----•------------------------------- ----•-••----•----------------------------------{-------------------- --------•----------- ------------------------------------------ -------------- I € I - -------- ------------------------------------------------------------!----- -- --- I hereby certify that-I have prepared this application and ?hat the work will be done 4n accordance with San Joaquin County ordinances, State laws, and rules and regulations of,the San Joaquin Local Health District. (Signed) = ------- --------------------------------------- -------------------------------------------------------------------(Owner and/or Contractor) By: J---•--•------------------------------------------- ----- Title -------- Y ---------------------- - (Title) - (Plot plan, showing size of lot, location of system in relation fo wells, buildings, etc.,-can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.----- - = -----------------------------w ------- DATE-- ---- REVIEWEDBY------------------ ---------------- --------------_------------------------------------------ DATE----- BUILDING PERMIT ISSUED •• ---------------------------------------------- - - ---------------------------------------- DATE---------------------------- ----------------------------- Alterations and/ r reco�tio�s- ,, ,. _ - ---- --- -- . ...�, , - ' --------- - —--- ------ --------------------------------------------- ------------------------------------------------------------------------- / I ---------- ---------- -- - ---- i--------------------------------------------- ----- ---- ---.-....-----•--------•--------------------------------•-------------•------------•----------- ., :--e�------------•--•------------------------------- -- ------------------- ------ --��--�- -----tea -- --- "= - ------------ FINAL INSPECTION jY.......... ------------------- ----------- Date-- -------------U ----------------------------- SM ------- -------------------SM J AQUIN LOCAL,HEALTH DISTRICT.. 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r�5 9 REVISED B-59 3M 3•'63 F.P.CO.