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FOR OFFICE USE: Permit No. -------------- ----------------------------------------- APPLICATION FOR SANITATION PERMIT -/_..��`�(----�---- - ------- .. - - - _(Complete in Duplicate) Date Issued -- -•---- _ _� _-.___ �: This Permit Ex fres 1 Year From Date Issue d install the work herein described. Application is hereby made to the San Joaquin Local-Healfh District for a permit to construct an This application is made in compliance with County Ordinance No. 549. t ' BoX 227B, halt. Graham Raac °ff__Ga1er)- JOB ADDRESS AND LOCATION---------R -- s Phone----369!&�©4-3_-------- Owner's Name3-3. 1 e1IC I2'�-L�Y'f ----------- - Rt 2Bax 22'7B, Galt Address. --- ---- ------ ------------- ----------- 14 p Box 4202 3actoP e 483-847--------- ,__- ---- ------ ------------------------------ Cal-�leetern sanitation enc. -�. --------- Contractor's Name-- -------- Other - - � � Trailer Court ❑ Mote! ❑ O er ❑ Apartment House ❑ Corrimerclal ❑ Installation will serve: Residence ® p � --------____ Number of living units: ._1---- Number of bedrooms _ --- Number of baths -":----. Lot size __--.""--___-- --- t Communit s stem Private M Dep#h-to Water Table Q4. ft- Water Supply: Public system.❑ Y Y y ❑ Hardpan k Character of soil to a depth of 3 feet: Sand,❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay Adobe❑ ❑ ious Application Made: lIf yes,dafie._-_-.---�-:--� -- -) NO El New Construction: Yeses] No ❑ FHA/VA: Yes E] No E3Prev pp -- TYPE OF INSTALLATION AND SPECIFICATIONS: .(No_septicaank or cesspool_perttted tf av public sfwer tsadable wtthtn.204 feet.) T _- -,0?---- Material 0 n re. e........ -- - Septic Tank: Distance from nearest well-. �QQ-� -Distance from foundation--__ 41 tIr Ca adt. �� P 41 No. of compartments `� Size.--5_t-8"' _die Liquid depth p Y T o nearest .y Disposal Field: Distance from nearest well----- ofom each line elOQ-t _'-___--.W'd#hcofttrench.-- Hine--201 ---- Number of lines------ --=_-----------------Length o 18--- t ain-_Rock th of filter material-._.. " --------:--Total length---- of filter ma. erial '_._"___ .- --_:.- p t Seepage Pit:-rl Distance to nearest ells �------- enc fUro��l nd5 ile nDiamete " Distan e to nearest lot line__ 5-t p _ _ 2� t ' Linin material_. r p Number of pits---.-----�---- g [ Distance from nearest well-----------------Distance from foundation--_-------.------ .fining rsiaterial-._-.. D Cesspool: is _-.Li Liquid Capacity gals. --Depth------------------------------------------- q p y-------------- i ❑ Size: Diameter.-'------ ---- ------ ' Distance from nearest building---------------- Privy: Distance from nearest well--------------------------------- --------- ------------------------- --------------------•------- - �. F1 Distance to nearest lot ine------------------------------------------------------ i r .�. Remodeling and/or repairing`[dea r's4 g�------------------------- ------ - ` = ------------- ----------------- ------------------- -------------------------------------------------------------- I - .} hat h --------- --------•---------------------------------------------------_------------------------ cation and f I hereby certify that I have prepared reppand edula s ap Ili ordinances, State laws, and rulesg the San Joaquin Local kHeall heDistr ctn done iaccordance with San Joaquin County i testi Inc.---------__- (Owner and/or Contractor) Si ned _ C a l%qe n "a - ( s 1 d _ --- Fres�dfnt-------...-. ----------------------------- (Title) - --A�- BY�= - - =µildin s=etc.;canTbeeplacedTon� reverse side).J`�` (Plof plan skowitig size'o of to ion. �s stem to relaton to wells, bu g ,. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------ -- -- -- - ----------------------- DATE r _¢ ------ DATE 5--------------------------- REVIEWED BY-------- ------------------------------------ -- ----------------- - D ATE------------------------------------------------------------ .= ' ------ ------- - DATE--------------------------------------------- -------- ------ BUILDINGPERMIT ISSUED--------------------------------y--------------.---------------------------------- ----------------------------------•-------------- Alterations and/or recommendations----------------------------- -------------------------------- Alterations ------------ ---------•------- - -/�f-� Date.- ------- ----------- - FINAL INSPECTION BY:. ._ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hat:etton Ave. 304 West Oak Street 124 sycamore Street 205 West 9th.-street Manteca,California Tracy,California � Stockton,California Lodi,California rS 9 REVISED B-59 31A 3-'63 F.P.CO: • ` •'`" i ,:ti.