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______________._--. APPLICATION FOR SANITATION P • ------ ------- - PERMIT Permit No. -•r/�'�----------- ------------ ---------- (Complete in Duplicate),. // --------- ------------ --- This Permit Expires 1 Year From Date Issued Date Issued Application is Hereby made to tb eco--r 9' �7 -he 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. E ,3 '6-8 S- r<F « P— d5* , y ip, �✓r?�T.S� J08 ADDRESS AND LOCATION..-%�ro Wfe Q `7 JIk Owner's Name--- ..y........................am --�r�- ------------- ---------------------- Phone---- ------------- Address � ------- ....... � --------•----•------------------------- ..----Contractor's Name----vrO- ----•- _te ------- -------- Phone,4�-Installation will will serve: Residence Q�_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/- Number of bedrooms _�3_ Number of baths CID �__ Lot size ______ -. '�f-s' Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table _40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay Er Adobe❑ Hardpan E] Previous Application Made: (If yes,date....................] No R' New Construction: Yes ❑ No [�J' FHA/VA: Yes [] No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i . I Septic Tank: Distance from nearest well-----_-----------Distance from foundation__._____-_----_{___.MateriafEl -________________________.________-_- ------------ No. of compartments--------------------------Size-------------------------------Liquid depth------------ ------------Capacity-----------•----------- Disposal Field: Distance from nearest well--------------- -Distance from foundation--------------------Distance to nearest lot line________:_____... ❑ 'Number of lines-----------------------------------Length of each line-----------------------_--- -.Width of trench Type of filter material-------------------------Depth of filter material-----------------------Total-length---- _.-------,-_______ --------------•---- Seepage Pit: Distance to nearest well---EfJi _______Distance from foundation____�S.C2--'__._.Distance to nearest lot line-----/-�' - rK Gf Number of pits._____ ----------Lini'ng material_eRA9. /<-----Size: Diameter____ ------Depth------•��- �` �'` -----------------• Cesspool:- Distance from nearest well----------------- from foundation--------------------Lining;material____._________-__ ❑ Size: Diameter---- --------------------- --------Depth--------------------------------------- -- - - ---Liquid Capacity------ --------------------ga€s. Privy: Distance from nearest well-------------------------------------------------Distance from nearest buildin I ❑ Distance to nearest lot line g - c Remodeling and/or repairing (describe) --epek- ----- ------------------------------------------- --- --------------------------- ---------------------- •------------- --•------------------------------------------------------------------------------- ---------------------- -------------------------- - - 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 Local Health District. (Signed)--------------- ��------ ------. . ------- _ ---- - and/or Contractor) By:---------------- ------------------ ----_�--------------------------------------------------------------- _ ------------------------------•------------------ -------_(Title)---------�---mer►- ------. ---- (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- REVIEWED ------i WED BY--=- --------------------------------------------------------------------------- -------------------------------------------- DATE ----------------------------- BUILDINGPERMIT ISSUED---------- ----------•---------- --------------- `---- ---------------------------------------------- DATE------------------------------------------- Alterations and/or recommendations: ------------------- . ---------- --- -- -- ---- ----------------•---------------------------------------------------------- -------------------- ---- ------------------------------------- --------------------- FINAL INSPECTION BY:------ .% DateR 177-/J SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FS 4 REVISED 8-59 3M 3-'63 F.P.CD. 0011-