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FOR OFFICE USE: _ �-- a_ Permit No. Z--a ------------------- APPLICATION FOR`' SANITATION PERMIT Date Issued iete in.,Duplicate)_ c --=� _. icomp .;s --- --------------- ------�----- --- "- ��• • lThis Permit Ex fires 1 Year From Date Issue ----- --- -- --- p,pplication is hereby m the San Joaquin Lacal Health District f or ade toh a permit to construct and install the work herein described. Y 549. This application is made in compliance with Coun#y Ordinance o. -a ------- -•------- c� I � / r ---- Phone.- --� ------- JOB ADDRESS AN D LOCATION__ 1 - -- - .. - ----�- `� -------------- ------------------------ Owner's - --------- --= - - ----- --•----- ------------------ Owner's Name------ ----------- I i � - c 1 s A____________________ Address.-_--1--(--)---• •-------------- _ Phone 1 ----------------------------------- -i---•------------------•---- o _�--_ CourtM tel ❑ Other --- Contractor`s Name_____"..._.-.-_ Commercial ❑ Trailer A art House ❑ C_..--•-- --- '= Installation will serve: Residence p Lot size --? _-- Number of baths - f f ' Number of living units: __ ____ Number of bedrooms - Private Depth to Water Table . ft Community system ❑ Adobe Hardpan ❑ Water Supply: Public system ❑ - ❑ Sand Loam ❑ Clay Loam❑ Clay ❑ t depth of 3 feet: Sand ❑ Gravel Y No ❑ FHA/VA; Yes ❑. No� s Character of sail to a dep No M New Construction: .Yes ] l Application Made: (if yes,.date----.._.._:--"---- I Previous f TYPE'OF INSTALLATION AND SPECIFICATIONS: ) __ P ermined'if:public sewer is available within 200 feet. v No septic.tank-or cess ool.p / ; t ---- -.Maer�a4_-------_�� = 1 ` k Sept"c.Tank: - ,. (�_._�-�-Liquid depth._..� - - - -- �Capacity._.__��-_�_._ Distance from "well__---�---Di$tan a from founds ion---- --- r, Size----•-- -- � r � No. of comp _ . t U Distance from f i ne_a{-fin= --�__-"t Disfiance to nearest lot Ine.-- - t (~ , �.j-��Width of trench--�.-•--- --:------ Disposal Field: Distance from nearest wel4--. --- -- ------------ 9th "--------- o Number of lines_ -" Length of each _ Total length---.----et - I �_---- Type of filter matenal�J�, - Depth of filter material._-----�- well_._____-__------------Distance from foundation-------------- Distance to nearest lot fine______.__-"-_"--- Seepage Pit: Distance to nearest Size: Diameter.---•---------"------- DePth---------- ❑ Number of pits- ------------- ----Lining material------------ - -- - - •g ---------------- ---------•--- _ � 9 • " gals. � Depth ------------- Liquid Capacity— _ _Linsn material Distance from.nearest well--------------- Distance from foundation.____----"----- ---------- -— Cesspool: - -- =r. - - r Size: Diameter ----- - - - ---- - � _ _-. " "p.istance from nearest building p - Distance from nearest well _-_ -- --_______ Privy: -------------------- ---- --- --------------------•---- '- ❑ Distance to nearest loft line_.--------- f_ - - ---- T - Remodeling and/or rape' ing (describe):__ / / {9-�rcJ t_----- = ------------------,----=--------------- ----------------------------------- ----- ----------------- --------- - --- --- -- cco d e - t - Joaquin --""-"""---- ----------------------------------- I re ared this application and that the work will be done in accordance with San Joaquin County hereby certify that I have,p P 1 Health District. ordinances, State lap. q ------------------------(Owner and/or Contractor] and rules and regulations o the San Joaquin Local - --------------------------- Sined � ---- -------------------- (Title)------ ------------------------------ _ ----------- � .. � ] -------=------------------------------- 1==---------------------------------------------"---- �; — --•---------------------- r. lot Ian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE--------------- ----------------------------------------- APPLICATION ACCEPTED BY _ - DATE-- } -- ---- ------------ DATE ---------- REVIEWED By------------------------- ------- - - -. --------------------------------- : BUILDING PERMIT ISSUED------------------------------------------- ---------------,----•----•----- Alterations and/or recommendations:---=--------------------------------------------- --•----------------•--- -------- ----------------------- _.__� ---------`-----------"--- t ___.•-__... ---------------•--------------------------------- ---- _._-_--_- ___. - - _ __________________ _____________ ----.___._-___."______.. -_._-___•----...._ __ --------------------------------------- - "--- --------------- ------------- ---------------------------------- ___________ ! .n -___- FINAL INSPECTION BY:---------;---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 205 west 9th Street 124 Sycamore Street 300 West Oak Street Tracy,California T601 E.Hazetton Ave. Lodi,California Manteca,tecar California Stockton,California " ES 9 REVISED 13-59 3M 3-'63 F.P•CD.