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FORUfFICE USE: ----------------- ----------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..l__.. f- ------ �.- 1ik---------- b� _ (Complete in Duplicate) Data Issued - This Permit Expires'l Year From Date Issued Y Application is hereby made to the San Joaquin.Local Health District for a permit to construct and install the work herein described. This application:is made ih compliance.with County Ordin nce No. 549. -------- --- - a _I? --� A.2��rC1 "----------------- JOB ADDRESS AND LO TON------------ ._ Phone. P - - 'Q�1- --------- Owner's Name--------'---=- ----- Address----• •---•---->��_G�fl1�-��_�-_----,(_�'/.A•N��----=---�- ------------------------------------------------------ --•--•--=-- ! -------- y. a C .-tea one. --- Ph Contractor's Name_____��(`� � -••-��---�---------- �- ' `..+"'��,� Tr.aile-ourt ❑ Motel ❑ Other ❑ Installation will serve: 'Residence, House ❑ Commercial ❑ _ �:t -_ Number of baths -_-�_-: Lot size ___�d --�-----�-�--b--------------------- Number -------- -----••----Number of living,units:._.�_____ Number of bedrooms __ *_ 1 Community s "tem Private De th to Water Tablet ft. Water Supply: Public syste �❑ Y Y ❑ P a de #1 of'3 feet: Sand Gravel ❑ San y Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Har >an ❑ Character of=soil-to p } New Construction: Yes ��o ❑ FHA/VA: Yes No Previous Ap.plicatjo`n Made: hf yes date__-- } No l � i 1 04"''- _ -TYPE OF.INSTALLATION AND SPECIFICATIONS: -�. —- (No septic>:tank or cesspool permitted_ if public is available within 200 feet.} x +'. Material t �-Y� T��---------- Septic T Distance from nearest well___ ------Distance from'foundation -------. U� No. of compartments_...__ ------Size---J.k X Liquid depth-----._._-----CaPacitY---- -------------• Distance from foundation _,� ---------Distance to nearest lot line__-. Disposal Field: Distance from nearest well._. ---Width of trench.___ - -_- Number of�lines� _ =- - ----•Length of each line__J4� --_:----- -- 7-------------- Total length Type,of filter�material___Ad41�-----Depth of filter material-----1 __------ g42 J 1 Seepage Pit: Distance to. earest well_____.___._.______Distance from foundation_______.- - BPCe to .nearest lot line_______________ - -------- Size: Diameter------_:1------- -----Depth------ ------ ❑ Number of pits----------=---- Lining material --- d Cesspool: Distance fr earest well'______________ _Distance from foundation-__._.----- material----..._______---_______-- ,j I ------- -De th--------------------------- Liquid Capacity gals. Diameter_*__________________ P -------------------------- Size: T ❑ t - ! ------- Distance from nearest building_________---______------------------------ ! Priv❑y: ...Distance from)n'earest well'----------------------------- ------------------- ---------- ------- Distance to-.nearest ------- I --w 40,rt #, G : ------------ ----------------- --- ----------------____ ` �._ --- - -_- Remodeling and/or reairing describe)--------------------------- --- -- ------6- !' �+ ---•-----•- 91Ott ---- --------------- -------------- ------------------------------ - ------: r_ _ -'--------•-- ...._-- _'._'--'- -___-'_ '__'-'- - - __ '-" I hereby,certify that 'I have prepared this application and that the work will'be done in accordance with San Joaquin County C ordinances State laws, and rules and regulations of the San J aqutn Local Health District' ':� - - --------------------- --.Owner and/or Contractor) (Signed) --- _- -- -- -- By:----- ==-----------= -------- ___1---------------- By: (Plot plan, showing size of lot, location of system in relation .to wells, buildings, etc., can be placed on reverse.side). h FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---.._-•I--- - - DATE----- "--Rt-0---- ---------------------- -- ---- ------------ ---------- ------ --------- DATE----------------------•---------------------------------- ---- ---- -- ---- - REVIEWED BY - DAE BUlLD1,NG�P..ERMITw155UED.___..•--_--'= ------ - = ----------------------------- Altera-Tions d/s�recommendations:------ h ' -`f k -------- - ------------•-------------------- .4u.a� •---- • - ,.. if i -------------------------------------- - ------------- --•---- --------------- - ----------------------- --------------- ------ F - _ ._ -- --- Date-------- --��---- ------•--- -�---- ------------ FINAL INSPE ON --- -- --- t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, r 300 West Oak Street 124 Sycamore Street 205 West 9th Street t lifornia Manteca,California Tracy,California Stockton,California Lodi,Ca ES 9 REV15FD 5-59 3M 3-•63 F.V.CC. r