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FOR OFFICE USE: --------------/.;-__3-e)___ ----------------------------------------- --------------- APPLICATION FOR SANITATION PERMIT Permit No. ___47...__... ------------ -------------------------------------------- (Complete in Duplicate) Date issued ... ---_--------_-------------------------.------------------ This Permit Expires 1 Year From Date Issued 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 in compliance with County Ordinance No. 549- JOB ADDRESS sLOCATION- - `E'er `�/-�- -------------•------------------------------r--- Owner's Name-- xw.:[�.�-- J c _..._____..-- -._. Phone. �� --- Address_ _ r__ = � --------------- -- ----- ------- -. �� / / Contractor's Name--- ------------------ -- -_---_CL>`:.c- ---..I--- - -- ---- ------ Phone__"_,,_r__,3-y�1 Installation will serve: Residence ��lpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _j__- Number of bedrooms __Number of baths _/--- Lot size 4.0--- ------------------ Water Supply: Public system [� Clmmunity system ❑ Private ❑ Depth to Water Table �;Qft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Er<arclpan ❑ Previous Application Made: (If yes,date---------.........I No ❑ New Construction: Yes [�5' No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wll !? �istan�g�from u datjon/LO'_r__.__.M _... L�r No. of compartments_._ —---------------Size _ _?� _Liquid depth__-- ___ _- __Capacity___g_ - _. --- Disposal Field: Distance from nearest well tVd2l-4,.- bistance from foundation---ie�Q_______.Distance to nearest lot line---15�___---- 4r___ Number of lines _ Length of each line___-- -�___P_-------------Width of trench-.-- .-- --F--<-- --------____-- _ �______________T e of filter materia _ Depth of filter material---_ Total length _______ 00 teLi : Distance to nearest well----------------------Distance from foundation---_-__-_--__----.Distance to nearest lot line--.-------------- , Number of pits----------------------Lining material-----------------------Size: Diameter----•------------- ----Depth----_---------------------------- } Cesspool: Distance from nearest well-----------------Distance from foundation........-----------.Lining material----------.--------.-_._---------_.--. .' ❑ Size: Diameter--------------------------- ----------Depth------------------------------•---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----___-----------------------------------------Distance from nearest building------------------------------------------ �h ❑ Distance to nearest lot line..--------- -------------------------------- -------------- ---------------------------------------------------------------------- Q� Remodeling and/or repairing (describe):___ -------------•---.-.-.----------------•---------------------------- ° f�--r - -•-- - ---- ------------------------------------------------ ---------•------------------------------------------------------------r---------------f---------------------------------------------------7- , ----------------------- k 1 __-------------------------_-____-__.___-___----_____-----------__________---.----_____.-._--_--__._------___-_____--_:.__-----_-__.._r.___-____--------__---_-_-_-_---___--.___------__--------_------_---..________._____ hereby certify that I have prepared this,application and that A6 w �k will be done in accordance with San Joaquin County' ordinances, 70( ws, an rules and regulations o the Sat Joaquin Lo al Health District. t \ 1 (Signed)----------------------- r 1 or_Contractor) ------ ------------------------- By:--------------------------------------____-.._-___.__-----------------------------.-_---- - __F_ -----(Title)------�_--------------_.-_-_-_........-...........-_-.._--._--- (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc- can be placed on reverse side).. a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- ------------- P�----------------------------------- DATE__ / r ! REVIEWEDBY----------------------------------------- --- -------------------------------- --- ------------------------------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-----------------_- i DA• E------------- Alterations and/or recommendations:----_____ _.__ `t- -cam ezG-�t,�. -••------------------- T - - _.------------- -- --------------------------------------------------------------- ------------ -------------------- -------------- --------------- -------� � ' c.i -Y`�� - - ----------------------•------- ,---- --�-------�`----- 1`'' ---------�---------------------------�----�--•--- FINAL INSPECTION BY:.---------- --------------------- `� ~� ----- ---•----- --------- Date---------- - --•-- ---- - -- - - -- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street' Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REViSED B-59 3M 3-'63 r.P.CC.