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SE--- FOR-OFFICE USE- ------------------------------------------- -----------------=--------- ------------ ------ ------------------_------_-----------------------------_- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------- -- ---------- (Complete in Duplicate) -_--- -..._ This Permit Expires 1 Year From Date Issued Date issued kl-� Z02 _2-3o_o f Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he ein described. This application is made in compliance with County Ordinance No. 549. ` 1,3 Hca JOB ADDRESS AW,-LOCATION-__ ---gi p p--..- (7' Owner's Name--------J'�----c-�J----- Phone Address-- � - -- r?.�. ---------------- - actor's Name Contrd: '�' cx-, ,� � �!> $ T { --------------------- Phone_.._ --6!s, Installation will-serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: __ ___ Number of bedrooms_ Number of.baths . Lot size ______I -____ ._ate __________ Water Supply: Public'system ❑ Community system ❑ Private kr5epfh to Water-Table ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ andy Loam [4 lay 'Loa`in=❑"Clay ❑ Adobe❑ Hard an I] Previous Application Made: (If yes,date--------------------I No New Construction: Yes No [� FHA/VA: Yes Hard ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ! (� (No septic tank or cesspool permitted if public sewer is available within 200 feet:) i Se Tank: Distance from nearest well?_ )-----_Dista ce from found - - 45� 4,_ - - r - -ation_I Material-- �pNo. of com artments__ T Liquid de th__.,�-,�:�Cpacify e - R Si _ Disposal Field: Distance from nearest well Distance from fouundation___ /_fY___.......Distance to nearest lot line-___A10_l Number of lines_„ -- -------------I ----..Length of each-line_____ p__"_________--__Width of trench_ -f-___________-___ Type.of filter material��r_ r__Depth''of filtdr material-------{-�_`-------Total length-------_---------�_�'_CJ_:'___-__-- .� Sv. Seepage Pit: Distance to nearest well________________ ----Distance�f om foundation_________________.Distance to nearest lot line_________________ S, Y _ Y Number of it 4------------------Lining maternal----------------------Size: Diameter-----------------------Depth--------------------------------- N Cess ool: Distance from lb p. p nearest well__________----.Distance,from.founda#ion-------------------_Lining material------------------------------------- Cesspoo -Depth----- -�----------------------- q P Y------------------------------gals. ❑ Size: Diameter-------------------------- ------ _-.--=----------------------- - -----�-. _Li Liquid Ca acct Privy: Distance from`nearest well-----------------------------------------------Distance from nearest building Distance to nearest lo+ line---------1- = ❑' 4-- i ----------�------------------------------------- --------- Remodeling:and repairing (describe):------ ---------------s--------- -------------_------------------•------------------------- -----------------------•---------- --•---------------'---•----------------•- - ' ^=;i ----------� -------------------------•--------------------------------'-----------•-------•-------------- ----------------- - ------------•-------------- --------= - -------------------------------- .i - - - - ---------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify;Lthat-1 haye_prepardd Phis applicatior`i and Lthaf the work will be one in accordance with San Joaquin County ordinances, State I no rule and recjulatians of` e, San Joaq Local a th istrict. + J [Signed} ------- BY: ---- -�--��------------------------06 r or Contactor) .... BY:---------------------------------------------------------------- ------------ �----eC - ------(Title)------- ---------------------=--------- ---- --- `----- (Plot plan, showing size of lot,.location of system in relatio a wells, bu,291g�, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. --- -'1-7__R_N_ ----°- - ---------------------------------------------------------- DATE------,/0 ._-- _ REVIEWED BY DATE N4- BUILDING PERMIT ISSUED-----------------------_-----------------------------------------------------=-------------- --------- DATE - Alterations and/or recommendations:------------------ -------------------- ------- ----------------------------------------=-------------------------------------- -------------------- ----------------------------------------------- ----------------- ----------------------------------------------------------------------••----------------- -•------------••-------------•---------- Ilk ------------------------------------- ---------------------------------------- -•---•-------------------•-•-----------------------------------------------------•-------------- --------- --- -----•----------------------------------- ------------------------------•------------------------------------ i ----------------- -----=----------- ------------- ----------------•-- ------------------------------------------------------------- ----------- FINAL INSPEC - Date--- ( r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California ES 9 REVISED a-59 31A 3-'63 G.p,CD.