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---------------- ---------- -------------------------- /6 /� // APPLICATION FOR SANITATION PERMIT Permit No. .47.:_/__-.,i��./e? -------------------------- ----------------------------- (Complefe in Duplicatel ------------ ----------- ----------- - -- This Permit Expires 1 Year From Date Issued Date Issued ----5 -47/ 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, JOB ADDRESS AND _,__ _ _ _ _ . LOCATION. _1. ------- -.�_- q ' � �i � ------------ ------------•--------------------------------- Owner's Name-------�---•-��=-G�.'_�_L��.----------�---f1-�"1-��J.�.��-�- --------------------------------------------- Phone----•------------------- Address--------------------- •-�_�.--- -�. _ ---------------------------_------------------------ r__ -. Contractor's Name.--------- - ------- --1120- .U, Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: __/_ Number of bedrooms _2-.._ Number of baths __-__ Lot size -----------'741-------- Water ___- - _ - Water Supply: Public system Community system ❑ Private=❑ Depth to Water Cable i;7 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Lo El❑ Cla Adobe Y ❑ �dpan ❑ Previous Application Made: (If yes,date-------_------------) No K' New Construction: Yes o ❑ FHA/VA: Yes ❑ No gj_� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) # Septic Tank: Distance from nearest well_____ ------Distanc from foundation__- `ice � p C 11 . Q* f Material P � --------------- No, of compartments__._-I�ICSize-__ �_,X -:--.Liquid depth-_.__ - - ��.?J-- CepacitY �6-�- Disposal veld: Distance from nearest well_____ ________Distance from foundation___- d._._---- Distance to nearest lot line. �------- Number of lines--------------J.- ----------_---Length of each line------- ---/---------- .Width of french- - -�/---------- Type of filter material _MT ,kTjepth of filter material___/_ �/�----.Total length---------f -Q_-!-_----- ------------ O Seepag it: Distance to nearest well------- ------------ Distancem foundation Number of pits------------- ------LLining materia ._ �: _f_ �- ----------Distance to nearest lot _l_ine_----- -c-,--- ----Size: Diameter_--�j/y.------Depth-s --- F -�Cesspool: Distance from nearest well----------------- from foundafion-----------------___Lining material -------- ❑ Size: Diameter----------------------------- --------Depth------------------------------------------ ------Liquid Capacity- ------------ -----------gals. Privy: Distance from nearest well----------------------------------------____`:!_Distance from nearest building----. F-1Distanceto nearest [of line---------- - - -------------------------------- ---------- - ---------------------- - --- ----------------------------- ---------------- Remodeling and/or repairing fdescribel_----------_____ """ 1r► --------------------------------•----------------------------•-------------------------•-------•-----•------------------------------------------ ------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la d r les an re lations of the San Joaquin Local Health District. Ligd) -_� ----------------------- ------------------ ---------------------(Owner BY:---------------- C t t an r on rac or) -- - -- -------- (Title) - plan, showing size of lot, to ti of-system-4n-relation,-to..wells 4n gsr-e#c.,-can-.be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- ------ --------- ---- v ------- ---------------------------------------- DATE-------- ` j� y/�--_- REVIEWED BY_. f y---------- --------- DATE--------------- --------- 111 ILDING PERMIT ISSUED------------------------------------------------------ ------------------------------ ------ ------------ - --------------------------------------------- DATE----------------------- Aterations and/or recommendations_______________________________- ----------------------------------------•----------------------------------------------------•-------------- FINAL INSPECTION BY:--------- - Date .- ----------- --- SAN JOAQUIN LOCAL HEALTHDISTRICT 1601 E.liaselton Ave. 300 West Oak Street 124 Sycamore Street , 205 West 9th Steer Stockton,California lode,California Manteca,California �,- Tracy,Californidf ES 9 REVISED H-59 3M 3-'63 F.P.CD.