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FOR OFFICE USE: J ----------•------- ------------------ -- / APPLICATION FOR SANITATION PERMIT , Permit ---------------------------------- #� .-�y �¢..r. _ (Com-plete in.Duplicate), Date Issued +�� . ` - ---------------- --------E----------- -- -,----..-. ---4-his Year,From°Date Issued Application is hereby madeto the San Joaquin Local Health District for a permit to construct and install the work herein described. This application isrmadeiny4ompliance with County Ordinance No. 549. Z.b �!D- a� n�Tc ;Z7�5. IID �F1rTHRc�#� D ` ----OF------ ----�_ P _ T JOB ADDRESS ANQ#LOCP.TION__________ __ ------------------------ _._ _________.____- 1 ! ��. !' U. " ----------------------------------------------------------- -------------- Phone 77A �3-2fW Owner's Name----- ---------------=+-L--••--------- ---�-�---- �-�----- Address_...... = `*... -------Z-�-J--�---------M O—E— 0 -------------------- -.... = t Contractors NameiL1Jl >=IFS----------- Phone -----"------------------------------------------------------------------------------•- Installation will serve: Residence ❑ Apartment House [Commercial ❑ Trailer Gourt ❑ Motel ❑ Other El Number oPGving'units:,._....__,Number:of_bedrooms .__ ____,N.umber:ofTatghs ___r- Lot�s¢esize-__9_ TC_K -- Water Supply: Public systefrn❑—Community system Private❑ Qepth rWaer Table _ __ ft. Character of,soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ t Previous Application Mader (If yes,date------------------_) No New Construction: Yes [-No ❑ FHA/VA: Yes ❑ No [T' TYPE OF INSTALLATION AND SPECIFICATIONS: S # (No septic tank or cesspool permitted if public sewer is avai able within 200 feet.) _ _ T Septic ank:i distance from nearest well `� Distance from foundation----- - Materi�}I___ l_ 1 �C� .Z X i No.rof compartments____ Z, -- .- Size,__..! .1..... Liquid depth __. x.,-------- .1 Capacity__________ __ __ _____ f 1 Dis oral e!a: D,if tante from nearest well----S_0---Distance from foundation-_._. _ _. _ �_`_____.Qistance to nearest lot line__________ 6s p Number;of {fines---_--- t -5� :-�S_.Width of trench._- �r__- - ---- -- ! ---------------------Length of each line__ ~"-- - _ - ( Ty e of1filter material__ p �_�_--_Depth. of filter material----1-______.___Total length_4�-�_F____'3_3_�-t�-_-47_`��___. Seepage Pit; Distan� to nearest well-------------_--------Distance from'foundation_______________.__..Distance to nearest lot line-----.____._____- ❑ Numberlof pifs----------------------Lining material---------------------Size: Diameter------------ -- e�pth�__T":---------- ---------------- . A Cesspool: A Distance from nearest well-----------------Distance from foundation_____________-----.Lining material:' i+ ------------------._______. (D w Size: Diameter---------------------- ---------------De,oth--------------------------------,- ------------- Liquid Capacity--------------------- gals. Privy: Distance.from,nearest well___________________I---------------------------_Distance from nearest building-_---------------------------------------- Distance _-_".______.________________--------._.Di ante to nearest lot'line--------------------)----------- ----------------------------•------- ---------------------------- --------------------------------------- y k O Remodeling',and/or repairing (describe): ---------------------------------------------------•----------------------------------- ------------------------------------------- --•---------------------------------- -- --•--------------------------------------- -------------s-------------------------------------------------------------------------------------------- ------------------- - i I l ) 1 ------- _ ! hereby certify tha'I have prepared this application and'that the work will be done in accordance with San Joaquin.-C---o--u--n-t- ounty ordinances, State laws, and rules and requiations of the San Joaquin Local Health District. + V0 Si ned /; - ----------- -(Owner and/or Contractor) I ----------------------------- ---------------(Title)------------------------- ---------. --- —(Plot-plan;showing-size1oflot;location,of,system-in-relation to-wells; buildings,--etc:,--can-be-placed-on-reverse side).-,# , t .F FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTEDBY------- ---------- -------------------------------------------- DATE -1 .'- i I't REVIEWED BY------------ � -------------------- ------ ------------------------------------------------------------------- ------ DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------i---- ----------------------------------------------------------- DATE------------------------------------------------------------ IAlterations and/or recommend tions:------------------ -- ------------------------------------------------------------------------------------------------•-------------•-----• ---------------- _ z-. . -------`,N,%JK----x.*: ,9_ ----- 4,.� r7A.'O_ -------------------------------------------------------- 'rt1� rtnl I S F ------�--{c------- ---------- 1� .. 0.. - -- ----- --------------------- ------ ----------------------�-----F f * -------- --- -----`-- ------ -- -- -, -- -"- ----- --} ---------=�-------------------- ----------------------- ----------------- - _ FINAL INSPECTION BY• ��--� -------.--- -- ------- - Date........... ----[• ----- --------------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 8-59 3M 3•'63 F.P.00. 6�n„