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FOR OFFICE USE: I` ----------------- ------- ---------- --------- - -------------------- ----- - i'._-- APPLICATION FOR SANITATION PERMIT Permit No. 'i I (Complete in Duplicate] / y / ,�. __..v _ Date Issued -------- --------y- ---� i This Per.mit Expires 1 Year From Date Issued Application is hereby mada'rto 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. Z� 0^2 , JOB ADDRESS AND L ATION,A4 -` / � Owner's Name;;-s. Irw ' ------• -- ----- ------ -----•": :1- ---- Phone- Address ------••--- >--•- _.X.. ------- --- ---- ---------- ---------------- ------ -------------= ' Contractor's Name------------------------------------ ---• - - ---- ----------------------------- -- j...---------------- Phone................................... Installation will serve: Residence til- Apartment Hous Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___1--- Number-of bedrooms __ Number of baths A_.tLotlsize ......_.2---A- Water Supply: Public system ❑ Community system ❑ Private,' Depth to,Water Table __ '_ ft. Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[X"" Hardpan ❑ Previous Application Made:i (if yes,date_________,.._.___.} No New Construction; Yes No ❑ 1 HA/VA: Yes ❑ No _ TYPE OF. INSTALLATION AND SPECIFICATIONS:._. } (No septic tank or cesspool permitted if public sewer is available within 200 feet.) A W� 11 4 Septic Tank: Distance p from nearest well_c . ___Distance r from found ation__t ---------Materiae No. of tom artments--_I 9 Size__- � _-_XS Quid depth__..-� C__----.Distance to neCaraepsta_c.lot.Y__ n_e -_-f:—�-_-�.--__.Dis osal Field: Distance from nearest wells __S7Distan fro fou ptiop_t_ Number€of lines_ r______________________ LengtFf�f eh lint __. "7.6Width of trench--- - -----------------•-- Type of'filter ma#erial__r _Depth of filter material__ _._-/_�-------- otal length___ _7_-_P------------------------. Seepage Pit: Distance to of pits------- --------------Lining material----------.- to nearest well_____.____._ ----_-_Distance'from'found tion`________________Distance to nearest lot line----------------- ❑ Number .� ......... Size.- Diameter-----------------------Depth - ---------------------- - . Cesspool: Distance from nearest well-----------------Distance from foundation______---------'.___..Lining material------------------------------------- .E ❑ Size: Dialmeter--------------------------------------Depth---------------------- -----Liquid Capacity----------- gals. . _,.� - : �.,._-.. .- - a -�_ Privyi "Disfance from nearest.well ___._..___ _____�____ _______________Distance ,from nearest Building------------------------------------------ Distanceto nearest lot line-------------- F------------ -----------------------------------------------------------------------------------------------------------...v f L Remodeling or p d - escribe :---------- ---l- ---1cr� and/or repairing --------- ---- hs '��r�� --------------------------------------------------------- =¢ ------------------ --- ---------------------------------- ------ ------------------------- ----------------------------------------------------- ---------- ------------------------- --------- =----------------------------------------------- - ------------------------------------------------------------------------------- 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 lrules and regulations of the San Joaquin local Health District. (Signed}----------�-�f- 'S ------------------------------`------- --------- --------------------------------(Owner and/or Contractor) $Y:---------------------------- ------------------------------------------------ -------- ----------------------------------- 'P'(Titlel-w° _ "-- (Plot plan, showing size of lot, location of system.in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1E APPLICATION ACCEPTED IBY DATE REVIEWED BY --------------------------------- --------- - ---------------------------- ----------- ------------ DATE------ BUILDING PERMIT ISSUEQ!p:------------------------------------------------------=--------- -------- --- DATE - - Alterations and/or recommendations:------------------------- - -------------------------------------------------•------------•---------------••---------- -------•---------------------------------------- ------------•--------------------I----•-------=--------------------------------------------------------------------------------------------------------------------------- ---------- -------------------------------•---- l --------------------------- II # i FINAL iNSPECTION BY-T- ,I ------ - --------- ----- - Date_-.- ---- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 1 300 West Oak Street. 124 sycamore Street 205 West 91h Street :1 Stockton,California ii Lodi,California Manteca,Caiifornia Tracy,California ES 9 REVISED 5-59 3M 3-'63 P'p.ra. �i �- it