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F R FFICE USE. r _ � APPLICATION FOR SANITATION PERMIT Permit ---------- ----------- (Complete in Duplicate) 6 ______ _----------------------------------------.--------- This Permit Expires 1 Year From Date Issued 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 AND_LOCATION-•-547------N. tll/_ X------------------------------------------------------------------------------------------------------ Owner's Name--------J&M_EEs. newel C f ----------------------------- - - -------------------------------------- Phone!7! - -f -/•3-- ------- Address------- .---- Address-------_----------------- Contractor's Name-----_ ___krC. ------ Phone./ -- _ �-p'j Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I*-___ Number of bedrooms _� _ Number of baths _-!�--- Lot size -------- _e` -_------------------- Water ---- ----------Water Supply: Public system ❑ Community system ❑ ' PrivateDepth to Water Table _&__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam T< Clay ❑ Adobe® Hardpan ❑ Previous Application Made: (if yes,date------_---_--.._--) No [K New Construction: Yes ❑ No JZ FHA/VA: Yes ❑ No)J TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: �G Distance from nearest well----------------- from foundation-_._.-____---.---.Material----_---------------------------_---------------- ❑E%I51'1 No. of compartments--------------------------Size--------------------------------Liquid depth------------------------..Capacity-------------------- _. Disposal Field: Distance from nearest well 1--._Distance from foundation------LR_-_--Distance to nearest lot line--_.'J---..5 -_-__- ®eXI5.T106 Number of lines-------------I---------------------Length of each line.--=--------------------Widfh of trench-----------2.4-x------------- ADD Type of Filter material---RA^t-i�-__._.Depth of filter material_--_-_1-0_.........Total length-------------------- Seepage Pit : Distance to nearest well....JLt0.........Distance from foundation------ ..--. Distance to nearest lot line-----:5 - ------- lICT004 #tOP Number of pits--------11------------Lining materialRc_l t----..Size: Diameter----•----33"_-----Depth.............44............. Cesspool: Distance from nearest well---- _---- ----Distance from foundation.___--- -------------Lining material--------------.---------------------- El Size: -_-___--- ----- Size: Diameter--------------------------------------De th----------------- --------------' Liquid Capacity-- -------------------------gals. Privy: Distance from nearest well-------------------------------------------- ---Distance from nearest building____-_____-_--_-___--___-----_.__--.-__-. ❑ Distance to nearest lot line------ ---------- - ---------------------------------------------------------------------------- ---------- -------------------------------- Remodeling --------Remodeling and/or repairing (describe):___.__A�?I__..--0---- X_�_5 _t_ ► ----------- e Ilam ._--._ ---------------------------------------------------------------------------•-------------------------------------------------------------------------------- -------------------------------------------------------------- - t = t --------------------------- ------------------------------•----•---------------------------------------------------------------------- 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 Local Health District. •� t I (Signed)- ----- ------ (Owner and/or Contractor) ____-_—i := ---- _ --------------------------------------(Title)---------- f------- (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----,L�_(------ ---- f -------------------------------- - ----- DATE-------® REVIEWEDBY------------------------- ---------- ---- -- -------------------------------------•--- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------- ti-----------------------------;---------------------- DATE-------------------F--------------------------------------- Alterations and/or recommendations:_____ .(-------------------------------------------------------------------------------------------- ---_.._ -------------------------------------------------•_---•---•.-_-_----_-._-_______._-_..-----.-_.--------.._.---------._------..-----------.--------_.._------..--------_...___-_--__----____---_---.-_------------------------- �/� /� FINAL INSPECTION BY-------- --. - __-- ----��-'-"4_.y----------- Date-------------------�.__-- ' AN JOAQUIN LOCAL HEALTH DISTRICT 1501 E.Hoseltan Ave. 00 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California - ES 9 REVISED 6-59 3M 3-'S3 F.P.CD.