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FOR OFFICE USE: - ------------------- ------------- + /S S I APPLICATION FOR SANITATION PERMIT Permit No. .........I..-_.... .. -- ------------------------------- (Complete in Duplicate) Date.Issued _- _- [q-_fr r.. �`-- , This permit`Ex ires`1 Year Froin Date lssued�" ------- ---------- ----------------------------------- i. Application•is hereby made'fo'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 Ordin4. a ce No. 549. t FASB B [t rr N• ",9i LV D . JOS ADDRESS AND` ATIO T,------ -- -o-'ey-, Owner's Name----------- ), ¢' ---' Phone---------------------- Address-----------------_----........ ,✓-� ------ Y-....CAIa......--------•--••-----......................•-•--------.- Contractor's Name______________________ _____ R_ 1 ... SD/�S----`---------------------------------- :._..... Phone. �J .%-07 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living .units: __1_____ Number of bedrooms .1;___ Number of baths _J<___- Lot size XV_1�:.�4`�_C`-.r--------------•-••---------•-- Water Supply: Public system ❑ Community system ❑ 'Private N Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Load(9 'Clay El Adobe❑� Hardpan F]Previous Application Made: jif.yes,'date--------------------I Noo New Construction: Yes ❑-'No'M FHA/VA: Yes ❑ No ) TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool`permitted if public sewer is available within 200 feet.) �i ImoY ' Septic Tank: Distance from nearest well___�C-------Distance from foundation__..-/Q._..___.Matenai_________________________________-_._____._�j. No, of compartments___�----------------Size_—!(3 ---, '_ lQ.:Liquid depth__-, -- -----------Capacity--�QO�-----t- + '%, I �� Disposal Field: Distance from nearest welL_ti577----:.:_Distance from foundation.....�d..�.___Distance to nearest lot line__________I_______ j 2 +r 1. [� Number of lines.____0?LQ_0 -------_--___ Length of each line___.��_��_._.Width of trench--- �___ _-------------_______ (� Type of filter matenal_ �L �S_ ` ___=Depth of filter material___/_ '--__-__I____Total length__________________ _ _________________ Seepage Pit: d Distance.to near stiwell,---------------------:Distance from foundation-------------- ___.Distance to nearest lot line-------_---- - ❑ , Number-of pits:------------------------Lining material-------------------____Size: Diameter-----------------------Depth------------------------------- Cesspool: ------------ ---------------Cesspool: Distance from nearest-well_';--------------.Distance from foundation---------------_-----Lining material------------------------------------- Size: Diameter------------------------=----------- Depth---------------------------- Liquid Capacity gals. O Privy: Distance from nearest well-----._-----------------------------------------Distance from nearest 1building____________________-___._.___.._____----. Distance.to nearest lot line------------------- ------------------------------------------ - --------------------- ------ , ti Remodeling and/or repairi (des bei: ` - R¢ ------- ------- . e -- --- ---------------- 1 1 __________________._-�_______.___...._.._..___________._.._______._________..-..________-.-_________._____.______-_-____-___________.--.________.____.________.____._-_..__________- 4 ________________________________________ ------------------------------------------------- ---------------------------------------- q I hereby,'certify that I h e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd r es and re lations_ f the.San Joaquin Local Health District, q ;� / x f [Owner and/or Contractor) Si ned ------------ ti r B �1 -----------------------{Title)------ • Y:- --- -= ---- (Plot plan, showing size of lot, ocation of system in relation to wells, buildings, etc., can be plat vn reverse side). + r FOR DEPARTMENT USE ONLY, 4— DATE--------- .- ------------------------ APPLICATION ACCEPTED BY----- ------------------------- ----------------------- - --- ------------------ ----------------------- F --------- REVIEWED BYJ------------------------------- --------------------- ....................... DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED---------- --------------------------__----------------------------------- ---------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------- --------------------------------------------__ *" =---=----• -------'-------------------------------------------------------.....-------- -------------------------I — ,_.._ � _ -- ..-. --r ------------------------------------------------------------------ -------------------------------'----`----•--- B ` ----------- _ ------------ ................ ---I----f:-'------------------------------•--------------------�--- ------------- BY: - Date-------------( � .---------------------------- FINAL INSPECTION : SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California Ea-9 REV,.E0 8-54 1,P tO.21 6.60 t J --