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Permit No. _�.�-�•_� } APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) 6 � Date Issued _____ This Permit Expires 1 Year From Date Issued Application is hereby made to the SaraJoaquin 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. JOB ADDRESS AND LOCATION---kf 1�` -Y--------------- ---------------�/' { - �- - --_--�-----•- - off( Ph e----------------------------------- ---------------------- ------------------••------------------- Owner s Name__-______________ ___ ____ 3 ,ice__ a o `l ---- --------------------------------------------- Address-----•-----•----------- -•7 ---:7-- --- � ------------"----------------------------- --------- ----- Phone - - --•------------- Contractor's Name--- -----••----- ---�--"'----- -- ------------ ------------- ----•------------- ----- Installation will serve: Residence Z Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .___ Number of bedrooms __ --_ Number of baths _ - ---------------`-- Number of living units: _� ____ Lot size __�-�-'�---�-- •------/ Water Supply: Public-system ❑ Community system ❑ Private Depth to Water Table ______-- ft. Adobe Hardpan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam M Clay Loam ® Clay ❑ ❑ ❑ Previous Application Made: Yes ❑ No � New Construction: Yes ❑ No FHA/VA: Yes ❑ No 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__.l_ __Distance from foundation_____Z Q__-_:_-.Mater,I----_-. ,,--sa- IY1 No. of compartmenfs------ �--------------Size----Z - 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_______.- ,-�_------- e Type of filter ma__ ---Depth of filter material-------l�-------Total length_____-'^7.' '" Seepage Pit: Distance to nearest well,.___!_G_�_ Distance from foundation--------------- to nearest lot line_______ _______ Linin matenaL_ _ _l am!- size: Diameter--�_�_X_X___Deptn____ __ 1-- -----• I- Number of pits___ -_- ,-';----- 9 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------------------gals. ❑ Size: Diameter ----------Depth-----------------------------------------_:---------Liquid Capacity---- - _. � ----------�----- - ------Distance from nearest building--------- ------------------------- ------ Privy: Distance from nearest well_______________-_.--- 1 . .❑ Distance to nearest lot line------ - ----------------- -- •--------------------------------- ---------------------------------------------------- --- Remodeling and/or repairing describe)----------------------- ---------- --------------•-----------------•------- =------------------------------------------------------•------------------ --------------•------ ----------------------•------•----------------- ----- -------------------------------------------------- ---------------------------- --------------- ---------------------------------- - ________ ----------------------------------------------------------------- I herebye lawsh andand regulations hrules ave ared this s elf the San JoaquinLocal Health District. ication and that the work will edone n accordance with San Joaquin County ordinances, +at AN [Signed) eeriK -------------------- {Owner and/or Contractor) By::-----Z " =- = =- x _ _ _- — ------------- - - (Title) -� (Plot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can a placed on reverse side). FOR DEPARTMENT USE ONLY DATE------------ F�"" Q------------------ 1 APPLICATION ACCEPTED BY-------------------------- --------------------- - • DATE-----------------------------------•----- ------------- REVIEWED BY----------------------------------------------------------- ----- ------------------------------------------------------------ " IBUILDING PERMIT ISSUED-------------------------------------------------------------------------------------- DATE Alterations and/or recommendations --------- __ _ ----------------------------------------- ---------- -------------------- ------------ ---------------------* ' -------------•--------------- ----- . r i -------------------------------- ----- FINAL INSPECTION BY,... .... ..... t__ ' --- - --.- ---- -- ------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT {._ 300 West Oak s+reef 132 Sycamore Strae+ 914 North "C" Street 13o.South. American Street "' Trac California Stockton; California Lodi, California Manteca, California Y ES-9-2M R Revised 0.'59 F.P.Ca,