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06 V8,APPLICATION FOR SANITATION PERMITPermit No. •'�� - [Complete-in Duplicate) - ^,1 Date issued ___.- This Permit Expire 1 Year From Date Issued` hereb made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Y This application is made in compliance with County Ordinance No. 544. JOB ADDRESS AND LOCATION___.___ ._ - � :�'----:=�---------------------------------------------------------- Owner's Name_ �':Y ��r- --------------------- !Zt! ----•----------•--------------••-------••---- -------------------------hon r Uj Address---------------- _... -------- e Contractor's Name--------- r� Other ❑ ---�, � Motet ❑ Installation will serve: :Residence ��Apartment House ❑ Commercial ❑ Trailer of size Number of living units: -__�_._ Number of bedrooms _ -- Number of baths __ ___ Lot size ___fv- _---- ._ _. +h to Water Table -------- ft. Water Supply: Public system Community system Cl Private ❑ Dep Ola Loam [3 Clay F] Adobe Hardpan Cl} Character of soil to a depth of 3 feet: Sand E] Gravel ElSandy Loam ❑ Y Previous Application Made: Yes El No1. New Construction: Yes E] No FHA/VA: Yes ❑ No [I t TYPE OF INSTALLATION AND SPECIFICATIONS: M t i [No septic tank or cesspool permitted if public sewer is available within 200 feet.) .; .4_: Septic Tank: Distance from nearest weil__ � --_-Distance from foundation--_--__-----_�____Material_______________P----'-y__.__ .--- -- -: No, of compartments Size--------------------- ---------Liquid depth-------------- --------Ca acit ❑ rb6 .Distance from foundation_.--�-f'--------Distance to nearest lac lin e---%f'�-------- � Disposal Field: Distance from nearest well_ -Len th of each line_____------- ----Width of trench.___ --- Number of lines ----------- g x - j _. f - aal--- =��_` .---To+a4 length---_So---- ---- Type of filter material__-l l !pp'i' ,D scan of fro+mr foundatio_%� - Distance to nearest lot line-�--�--------- Seepage Pit: Distance to nearest well___-- - Number of pits..-.-.E--------------Lining mater �� Size: Diameter_ __Depth -0-------- ------ Distance from nearest wail-----------------Distance from foundation,------------------.Lining material__-_..______------- -------"_.als. Cesspool: ----------Liquid Capacity----------------------------9 ❑ i Size: Diameter--------------------- Depth Privy: Distance from nearest well------------------------------------------------- ilding Distance from nearest- u----------------------- -----•- ---- ------ ------------ Distance ----- -- ----------------=--- --------- ❑ Distance to nearest lot line_________________________ � ---------------- ------;---�----•------------------- ---------------------------------------•------------:--• Remodeling and/or repairing (describe):.__.__._...____.-- _._-.._ � -- 11 ---- - -------------------- ------------------------ --------------------- Y - -------------------------------------- --------- -- -- .- .� --------- s -.9. 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 focal Health District. T� j (Owner and/or Contract ------ --- ------------- - [O d�° Contractor) (Signed) �� .t = -_ ------------------------------------------ - k ----------- ----------------------------------- -------- --------- Title) :---_---.-g_•-- - y.. . ;CF eplaced on reverse side]. (Plot plan, showin size of Jot, location of s stem m relation to wells, buildings, etc., can be �. FOR DEPARTMENT USE ONLY f - DATE ._ !L j-----`�----- ------------------- 1 APPLICATION ACCEPTED BY:__ '-- � REVIEWED BY------------------------------------------ -- ---- ------------------------- DATE---•- ---------- ------ ... BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------- ---------------r DATE Alterations and or recommendations: f -------------•-- ----------- ---- :_ 0.7 -- i'9- ------ ------ -- b f _ ._-.-''-P�1 _ _ _____ ---•-------•--- - ____.__-.__...__.___._..__ ` r __._________________________________---------------- -------- ____ __________ lt 1 ------------ ---- - - --- -_pae;�;, ---- --- -- - - - -- Date-----�_'.2 --- -- a-- ----------------- FINAL --- ---------- E FINAL INSPECT) 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 914 North "C" Street 1 132 Sycamore Street E 130 South American Street 300 West Oak Street Tracy, California j Lodi, California Manteca, California Stockfon, California ES-9-2M Revised 8-'59 F.P.Co. _ _