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FOR OFFICE USE: : �,3Sr F fiy r ` APPLIgATM FO SANITATION PERMIT Permit No. ..1. --. • - ----- -- ---------------------------------- ------------- (Complete in Duplicate) 4 3 ------------------- - - Date issued ---,.-_-___-------- --------- ------------------------- ___-_ :;._._ This Permit Expires 1 Year From 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 r LOCATION----..�'�-d.`V -----�-----�Yj-`�-i'--'"-----�c'.�.I� --------------------------------------------•-----------'---------- Owner's Name------4- d,es. ---------- :.�- Phone------- Address �� ••4_ ----11 �_�r.�- P�/ ---------------•-•------------------„------------ Contractor's Name-------d9 .t - _-- -- Phone__ 7_ �. __ _____________________________________________________________________ Installation will serve: 'Residence R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _ ___ Number of baths _a..__ Lot size ____k4_ _A_.jj_p_f_______________I________ Water Supply: Public system 59- Community system ❑ Private ❑ Depth to Water Table -------- ft. i t Character of soil to a depth of 3 feet: Sand [3 Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8- Hardpan ❑ Previous Application Made: (If yes,date----------- ------) No ®` New Construction: Yes @9-- No ❑ PHA/VA: Yes ❑ No : e TYPE'OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if' public sewer-is available within 200 feet.) Septic Tank: Distance from nearest well a ±�__D stance from foundation___f'0-----------Material_.R klc�°_4v(------------------ __ No. of compartments------A----------------Size_ Q_5` ?(-?_Liquid depth-----V--_---------------Capacity_1?-a_G' _ Disposal Field: Distance from nearest well.Wo-&-.c__-Distance from foundation---/_Q------------Distance to nearest lot line_S----__._____ i Number of lines------- -------------------------Length of each line________�a----------------Width of trench-.-_4- ---------- Type of filter..material---4_ /`_______Depth of filter material-__-iX`_'_____..Total length------ W c4- -- J Seepage Pit: Distance to nearest -------Distance from foundation__f_!?i............Distance to nearest lot line__4.___-------- 6 � Number of pits._.__Av� n ______'_____Lining mateal---_r1s7s_k__...5ize: Diameter_._.0_..-- _ _ .-____.Dep th_____-z-sl.____._---_______ S Cesspool: Distance from nearest well----------------- Distance from foundation----------------._..Lining material_._.-_._.___------________I---------- . Size: Diameter______________ 'fes ____Li Liquid Capacity 1A ------------��"-------Depth------------------------ - --------------- q p Y------------------------=---gals. Privy: Distance from nearest we __e_____________---_______-___ -----Distance from nearest building_.,__-__________._______--.____-_.._--_-_. ❑ Distance to nearest lot line----------------------------- ----- - -----•--------------------------------------- ---------- Remcdelin and/or repairing describe):_:-:-------------- ----------------------------------- --------•-------------------==---------.---------- I ---------------------------------------------------------------------------•--••-------------------------------------------_--------•---•---- .,-. ------- ------------------- --------------- -------------------- �. i t ----------------------------- -.-_--------=------------- .: _._-,:_:------------------ I h4re6y certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 0- ordinances, State laws, arules and regulations of the San Joaquin Local Health District. 1 9 (Signed)--------- ! � ------- ------------------- ------------- ------(Owner and/or Contractor)) -., 4 t f By:-------- -------- - [ritlep ; (Plot plan, showing size of lot, location of system.in relation to wells, buildings.,etc.,�can.?p laced on reverse side. . t ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------------- S ------------=------------------------- DATE--------------- --- ----rte ----��--------- REVIEWEDBY----------- 1----- --------- -------------------------------- ---------- ------------------ DATE------ --- ------ ------------- / BUILDINGPERMIT ISSUED-------------------- --------------------V-------- ----------------- i------------------------ DATE--------------------� Alterations an /or recommendations -'zA` �_ 1�1 ---� ,,��. N-- p-�, fs' --• - --------- ----- -------- ------ --�-------� "''el �------------------- -- -- ------------------------- -- --------- ---------- f ------------------------------------------- ----------------------------------•------------- ----------------• •------------- --------------------•-•-------------------------- -----------------------------------;---------- FINAL INSPECTION BY:----- ------------- - -----�----------------------------- Date -----`- / _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 1 1124 Sycamore.Street�' 205 West 9tk Street Stockton,California Lodi,California Manteca,California 1 Tracy,California E5 9 R"ISED 8.59 3M 3-'63 F.P.CC. q � SE