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�3 i-- -------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . 2. :r7 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. [fS3_<<: s . rs,..eyr Zo'7 - ! zo--ny JOB ADDRE=SS AND LOC TION ../ .. � - a, ?{- Owners Name------- 7-7 -- - --• -------------•---- -- --------------- ----------- Address ne ---- --- Address------------------ _j__4 --•----• --- - �rl7,c _ --- -- - �j - ---- -- ---- Contractor's Name---------.11lrlf �_. n��l_ __ rsQ ._cS one...............•----••-------____-• Ins+alta+ion will serve: Residence [Appartment House Commercial Tra1 e�rt ❑ ❑ ❑ Motel ❑ Other ❑ Number of living units: -----/- Number of bedrooms _ . Number of baths Lot size --- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table,93_ ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sa y Loam E] Clay Loam C ay ❑ Adobe IDHardpan ❑ Previous Application Made: (If yes,date_______________-_.-) No iNew Construction: Yes No ❑ FHA/VA: Yes ❑ Nol�4 � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)` Septic Teak: Distance from nearest well _ --_- Distancq from found tion-___��_______Mate ial�___. �. No, of compartments----------�- Size �.��_� �-- iquid depth--------- '-----------Capacityr Dispoos�f�ld: Distance from nearest well.-. ____-_.-_-_Distance from foundation________ ---t.Distance to nearest lot e__-5 Number of lines____________ _e,� Len th of each fi �1 � �^/ - g �a"l�_. idth of trench ---------- ---------- Type - --•-- of filter materiats!_ G_l%__ __ Depth of filter material-----IX— --------Total length____________ _ Seepage Pit: Distance to nearest well-----f4--_7F"--- istance from_ foundation__%,0__f�,Dist�}ce to nearest lot iine...... Number of pits-----------/--------Lining material___llo�`-------Size: Pier�we�+erixf�IAF4 q.___Depth------ Lf_� Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material------.--___-_.________-_._ El Size: Diameter---------------------- --------------Depth---------------------------------------------------Liquid Capacity- --------------------------gals- Privy: Distance from nearest well-______________________________________---------Distance from nearest building------------------------------------ El Distance to nearest lot line----------------------------------- Remodeling and/or repairing (describe):------------------------------------- ------------------------------- ------------------ --------------------------------------------•-•------------------ I hereby certify that I have prepared this application and that the work will be done'in accordance with San Joaquin County ordinance +ate laws, s and regulations of the San Joaquin Local Health District. (Signed)-.- , ---( ) --- D77 --------------- -- ----------•---------------- • ------------ - caner B r. - --(Title) a (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ` C ------------------- ---------------------------------------------- DATE REVIEWEDBY----------------------------------------------------------I------------------------------------------------------------------- DATE------ BUILDINGPERMIT ISSUED - DATE Alterations an_, , recommendations:. ---- ---------------- --------------•-------------•------------------- --------------------------------------------- - --- -•-------- j6 _--13�6`fn:- Z-------------------- ----------- ---------- ------------------------------- ----- ---- - -- ------------- ------------------------------------------------------------------------------------------ A—Y 10 FINAL INSPECTION BY:- C- �- ------------------------------- Date /3�6� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 31V 3-'463 F.P.CC.