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FOR OFFICE USE: - -----------------:------------------------------------- -------------_ APPLICATION FOR SANITATION PERMIT Permit No. f_1xB/Z.. ------------ --------�4_----- --------------------- ; (Complete in Duplicate) / I This Permit Ex ires 1 Year-from Date Issued Date Issued _r ��,L6__� lqp- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I�/T/hii]s�afp./plication isM'm-aJld/e in coom Ii®ante with County Ordinance No. 549. - JOB ADDRESS AND LOC TION__;______ '---------------------------------lc%. Owner's Name-•-____-- - Phone- Ab-- -- --- --- . .---•-•------------------•---------••------••----._....---------- •---•---•------------ Contractor's Name----------- --t-----------•---------------------------------------------------------- Phone--YiK -- U.93--- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Mote! [] Other ❑ f Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size _________________ __-_...._.....____.__ Water Supply: Public system ❑ ` Community system ❑ Private PC Depth to Water Table .- - ft. r Character of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------ ) No M New Construction: Yes Cg No ❑ FHA/VA: Yes ❑ Noxi t TYPE OF�INSTA LATION AND SPECIFICATIONS:' (No septic tank or cesspool permitted -if public sewer is available within 200 feet.} r .-----.Material-- M-��?s% Septic Tank: Distance from nearest well__J? __-._.Distance from foundation__. 1 No!of compaefinents._.� ________________Size_h ___ __A�.___Liquid depth___��--._-_______CapacityAp --�zYQo Disposal Field: Distance from nearest Distance from foundation------/_,Q ____.Distance to nearest lot line___ --__. Eir- Number of ---- g r _--_-------- -Len Length of each line-/-�--------------- ----Width of tranch.-----'�--,---------------_----- _ P i .. �`• _ g a Type-of filter mafierial. �._E2¢ / e th of filter material__ __- ::.._Total len th:_7'a__0_°_":"";'"�_�_ .A •, .� , .. r. Seepage Pit: Distance to nearest well ""`°'"-----------Distance�, from found.ation ________ _____Distance to nearest lot line----------------- G ❑ Number of pits------------------""Lining material---- Size: Diameter---------- •----.--__-Depth-_----•--.-_---------------____-- _ q, 3, Cesspool: Distance from nearest well_________________Distance from foundation.__.---____...'__-.Lining material_------------.-______.____________- � ❑ Size: Diameter------•- ------------------------- Depth------------------:---------------------------- ---Liquid Capacity----------------------------gals. t1 Privy: Distance from nearestwell-__._---- ________ "Distance,°from nearest building_'-------------_._-_____________________- ❑ Distance to nearest lot line--------------------------------- - ------- ---•--------------------- --------------•------------------------------------------------------- , Remodeling and/or repairing (describe):-------Q--_,ZCr-oo-----`--4__X.e �-- - --- -------------------------------------- ------------- - •---------------•--. . .-- -------------•---------------------------------------------------- ..---------------..._------------------ •---•--- - � ------------------------------------ - s K-- .. �. - $ 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]---_----__- --_-- m^ ;_.�.y _ �-- _ -- -. .--;-- f caner and/or Contractor) •�_ --...:�.�.�i a r—o�. _-�. -�-'�_ By:------� j_Jtc 'N------ i(,,.. -----(Title)---- - - =. (Plot plan, showing size of lot, location system in.relation to wells, buildings, etc., can.be placed on reverse side). } `F097DEPARtMENVUSE-ONLY'-- APPLICATION NLY'APPLICATION ACCEPTED BY_ - t 3 i # ---------------- - -------------------- --- - DATE---�----�1- --- -------------------=------- -- REVIEW ED BY------------------------------------'-l---------------------------- ------------------------------ <,e# -- DATE-------------= - BUILDING PERMIT ISSUED -� --------------------- DATE----- --------•-------------------------------------------- --- ------ --------- ----- - ------------------ Alterations and/or recommendations•--4C1/- __ Ln(-(��--TQ_____ ____ EF ._ _ ___.__.__ ----------------------------------- VFREh---._w!_TH------ L-A ------- ------------------------------------- ------------------------------------- ------------------------------------------------- - --------------- ------ --------------------- ---------------- --- ------ : -------- -- -- -- -- - -- - - -- FINAL INSPECTI - ---- ------ Date_... _ -_/.U :_f? _.�~� 4 _ _.'.__.'._'_'__-'--------'--'---' I Y; SAN JO QUIN LOCALEHEALTH 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 ES 9 REVISED B-59 3M 3•'63 F.P.Cp.