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FOR OFFICE USE: ----------- ------------------------------ ------- E ------_-----_-----_---------------------_------_-.-- APPLICATION FOR SANITATION PERMIT Permit No. ----------------- -------------- ------------- ate] -1 �f /y -.-." This permit Expires e 1 YearFromDate Issued Date Issued ___ _ _/_ _____(t P P rr� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t,piw`or�C�in-desct'r'ITe-d. This application is made in cgmpliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIONS--- ----- T_H[zoo------- ,�zc___ ___ --------- _...l t_ .P - _1 `______ __ �yTl w�0-tom -- �_ _ 07H ------ --------- - Owner s Name Phone .. Address--------------- .-4..lok 6 - ' --- - -- Contractor's Name 1 ��' ---------------------------------•----•------ -------------------------------------------- Phone--------•-----------.-__-----_--- � Installation will serve: Residence Apartment House ❑\Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. ____ Number of bedrooms -"Number of baths __/_- Lot size ----fiCR�----------------___________-_____-_- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _-?r__-_'ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay Q Adobe [) Hardpan ❑ Previous Application Made: (If yes,date_----- ------------) No New Construction: Yes No ❑ FHA/VA: Yes ❑ No ®' TYPE OF INSTALLATION AND SPECIFICATIONS: a 14 __ _ , (No septic tank or cesspool perrnitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----__-___�_Distance from foundation---------------------Material---------------------------______________________ It I Li-Liquid de th}_..+_:r_.. _r_ ' Capacity�X��! No. of compartments p Size •--------•-------•----•-- q P. .r �;---- P Y Disposal Field: Distance from nearest wel!___�©.-----Distance from ifoundation._.�0------__.Distance to nearest lot line----��7_ Z FX�T/NG— Number of lines_------------/------- -------------Length of each line______ _ _'___�--_____.Width of,french-------- _.-___----_._.___._._ v+ •-I— /gUD Type of filter material____ G`C. _.Depth of filter material____._ _r_.___ Total, length-__.___..5©________________________ Seepage Pit: Distance to nearest well--------------_--------Distance from founclation---------------------Distance to nearest lot line_____________._- 1* ❑ Number of pits---------------- -----Lining material---------- #--Size: Diameter__.---------I----1.J__Depth--------------------------------- Cesspool: Distance from nearest well_______________JDistance from foundation----------- ------__Lining material------..__.__-___________._________ ❑ Size: Diameter------------------ -------- ---------Depth-------I----------------------------------E-------Liquid Capacity------------------ --- -----gals. • r i iI Priv Distance from nearest well____________________________f----------------bistance.from nearest building, ❑ Distance to nearest lot line-------------------- ------f------------------------------------•------------------=-' } E or I }[ Remodeling and/or repairing (describe):----------___________.._.k I --------------- -------=------•--•-------•---------------------------- --•--••------•---------•--------------------------------------------------------------------y -+-------------- ------ -- 0 1 I 1 ; -------- -----------• --------------------------------------------------------•------------ ---------------------------------------------------------- - ----------------------------------------_------------_------------------------------------------------------________•.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 rules and regulations of the San Joaquin L'ocal'Health District. I (Signed}__ ----------------------------------------------------------1-------(Owner and/or Contractorl -y -- T--.. ---- -- -------------- (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 APPLICATION ACCEPTED BY----------�--1-R-•-0-------------------------------------------------------------------- DATE---------- REVIEWED --------REVIEWED BY--------------------- - ------------------------------------------------------------------------------- DATE--------------------------- BUILDINGPERMIT ISSUED------ `--------------------------------------- -----------—----•--------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:---------------------------------------- ------------- r ------------------- ----------------------------------------------------- .. t " -•---•--••--------•-------•-•-----------------------•----------------- -----------------------------------------------------------------------------•-----------------------------------------------••---------------------- --------------------------------------------------------------•-- -------- -----------------------------------------------------------------------------------••-•-•-----------------•------------------------------------•-•- ---•-•-----•----------•----------- -----------•------------- ------- ------------- ------- ----------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- ------- ................. ------- ---- -- ------------------ -- ---------- FINAL INSPE16 Date--�- -- -------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT TV M LSQ►� 1601 E.Haselton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California C5 9 REVISED 8-59 3m 3-'63 F.p.0 O '7/q- 3-'4q4 2-- 4-q- /9,nl. ._ - - d