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FOR OFFICE USE: ---•,�--- �-yvk-•---.......{�7-�"------------ - ,. � _1 b 66.E ......._,r...............r.�—. �__-f......... APPLICATION FOR SANITATION PERMIT Permit No. _. _._._•--.•-__.._.__ `� 3d {Complete in Duplicate} ' - --- - This Expires 1 Year,From Date Issued 'Date Issued _.. Application is hereby made.to,the_San.Joaquin,Local_Health,Distr ct f_o 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_._f'fA e..44'-. Owner's Name -.. ..... ..^' Phone Address-..._. - •-----•---•-•---•-------------------••--•....................................................- Contractor's ,Name..:;:. a /e .... 'I..i.... .y-'. ............................................. ....:•..,,Phone................................... Installation will serve:✓Residence 114�partment'House-❑- ComMLXr4641`❑' Trailer Court- M oteI2Q--Other ❑ t � l � / : Number of living units: .�..,Number of.bedrooms . Number of baths .. Lot size / _/ ... �•y Water.Supply: Public Isystem ❑ . Community system �'txrivate ❑ Depth to Water Table � ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe e—Tiardpan ❑ Previous Application Made: (If yes,date...........:........I No New Construction:'Yes Ug"IQo W* FHA/VA: Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tan0orl cesspool permitted if public sewer is available within 200 feet.). Septic Tank: Distance Boni newest well''° —"Distarice''from'fouridation.. No. of cor5ipartments_., e.y'� ...X. r'�~:tiquid depth._.. .. ........:...Capacity. ........... Disposal Field: Distance'from neares well.- 77..".....Distance f ogn foyndafio L9..._._...Distance to nearest lot line .......... Number of lines.._... .' .. _... .Length of-( line _ . r�WO of trench-..;.Z........... Type of filter material Depth of filter material._, y.......Total length...:.__../ i i i Seepage Distance to nearest well----_.'--^''..._._Distance fr m fo dation __'-:_. is nce to nearest lot a _...: . �� Number of.pits--.p�....-....R..Liningmaterial. u .Sizs:._Diameter„��...': Depth.r��af---- 0. �j�!�� Cesspool: Distance from nearest well................Distance from foundation....................Lining materiol....... .. , ❑ Size: Diameter.,............. Depth......................................... ...........4iquid Capacity..................:__.......gals. d I Privy: Distance from nearest well.................................................Distance from nearest.building.j.........._..............:. . ❑ Disfance to nearest lot line. .......... .................... • ••----•..... ..... ..... ......................... Remodeling and/or repairing (describe):.......... ... J ___..._................................... `. .......... ........................................................................ -•.................................................•...-----....._.............................................._......----•-----..........------.......•---••--_-------------........ ....................................... ....................... ..•---.-_._.........._..---.........---•-•---•-•--••......_.............................---..............---..............-.------......-:••----..............._....................................................... I hereby certify thlat I have prepared this application and that the work will 6e done-in.accordance with San Joaquin County ordinances, State laws,)and rules and regulations of the San,Joaguin,Local Health District. (Signed).............. ... ........... . .. ........ --........_... .......,.. _Awnere+ �or Contractor) iy2'P 1� (Plot plan, showing size of lot, location of syste relation to wells,'.buildings, etc., can be pace! d�reve�se side}. . , FOR DEPARTMENT USE ONLY { 1APPLICATION ACCEPTED BY..: '�~ •- - ��L�'............. .............................•---••-•-•-----...------------..""DATE.----------�----��,-------- --- -----.. 'REVIEWED BY................................................_..--•---..............................-- --............._................. DATE...._......._..---•--.._..._...._.. i 16UILDING PERMIT ISSUED................••------•-•-..... - ................... ............ :s . + DATE...,.................... ....._••••-- . ...•.. ...VAlterations and/or recommendations:.___ —...... . �.. , c � .... ........ ...r. � .r� ......... �c�� , -----•--......--•-----•••-•--•-••-••-•----••---..... ..............................-- r "- w FINAL INSPECTION BY:. Date. / .. . G / Gt�r.,rL�................ Date.............f! .� SAN JOAQUIN LOCAL+IEA1 H DI TRICTf t,) 1601 E.Hazelton Ave. N 300 West Oak Street 124 Sycamore Street ` 203 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California @t+ 9 R@VIS[D 9.54 7M 3-'63 F.P.CD.