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t-UX1lr*l(.t U5E: i ------------------------/ �s • " /s-e APPLICATION FOR SANITATION PERMIT" Permit No. . --71 9f --------------- ---------------------- (Complete in Duplicate) 7 I - ---------------------------- -------------- -�� This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made tollth San Joaquin Local Healfh 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 _Z.�3__3____� �1 - - --•------------------ Owner's Name- A - -- --- ----- --- --- I'hone__.--------------------------------- ---Address Contractor's Name------ -- ------------ - -- - -----•�---------------144�----------------•--------------._....-------- ._._ ..------- Phone---------------------------------- Installation ---------------------- -Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___I___ Number of bedrooms 3._ Number of baths __I____ Lot size -----9.�,_4! --------------------------------------- Water Supply: Public system [3Community system E] Private Depth to Water Table eke ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0:-<,dpan ❑�, Previous Application Made: (If yes,date-----------:--------) No [j�-- New Construction: Yes []�,-No ❑ FNA/VA: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS: {�1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r ptic nk: Distance from nearest well_�G___----Distance from foundation--/_0____--___.Materia l___,(------------------------------------------ Se �. __ Size_- X` Y 9--------Liquid depth----�-----------------Capacity.__�"q"- -'c No. of compartments_____ _ ________ _______ Disposal Field: Distance from nearest well_ O- ---Distance from foundation._ _p_____._._._.Distance to nearest lot line_______-.�___.. Number of lines-----t7-_____ =- of trench--i__1---_---------------__- .J Type of filter material-�pC�-----------Depth of filter material./�-----------------Total length,____/sS7t?__------------------------ See ______________________Seep Pit: Distance to nearest well__4p_-----_______Distance from foundation___4d_r.___.__Dhance t , erest lot I•ne_! _� ----- WL� pf � Uze: Diameter. .------y_.-__ Depth___._ _S Number of pits---- --------------Lining material--- _-.__.Si Cesspool: Distance fi-om nearest well ________________Distance from foundation-------------------.Lining material_____---.__.__.______--_________--_. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. A Privy: Distance from nearest well---------------------------------------------- -.--Distance from nearest building---------- -.___________._,-_ F1 Distance to nearest lot line---- - -------------------------- --------- •----- ----------------------------------- . ------------- Remodeling and/or repairing (describe)-------------------------------------------------------------------------- --•---------------•----------------------------------------- ----- -----------------------------------------•---------------------------•------ --------------- -- ------ --------------------------- ------------------•------------------------------------------------------- ------------------------------------- ------------------------------ 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. {Si ned -------------- --(Owner and/or Contractor) 9 ) ---------------< BY: --------------------------------------------------------------(Title) - ---- -------------------- -- -------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------------- APPLiCATfON ACCEPTED r `------------------------------------ DATE REVIEWEDBY- ------------------------------------------- ------------------------------------------------------------ DATE BUILDING PERMIT ISSUED----------------------------------------------------------- omr - +— -- DATE-------------- ------------ Alterations and or rgco_mm,e� dations: ------------------------I �t � f - ------- -- ---------------------- � ------- - =---- - � Qa � 4 ---` [ ..7-� -� ........ C - A- _4 --- ---- . Ems'.--------------------- FINAL INSPECTION BY:------�.:r --------------------- (V/---- ----------- / Date----- SAN JOAQUIN LOCAL HEALTH DISTRICT f 1601 E.Hazelton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California REVISED B-59 3M 3-'63 F.P.CO.