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FOROFFICE USE: --11-74 ----------------- .9- e-- `---------------- APPLICATION ,FOR SANITATION PERMIT Permit No. 44P ................... ------ -------------------------------------------------- {Complete in Dualh.'cate} ------- - - ----- -- This Permit Expires 1 Year From Date IssuedDate Issued 19'3-300- z& 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. 61V E. XhC I LL C7- OB ADDRESS AND LOC ATI N___l[�__- ___- ------- -------- 2--- - h Owner's Name-- -- -•--••---- - ------------------•---- --- Phone----------------------------------- Address---l_oe-----� -- ---- --------- Contractor's Name --e-- --- -- _ _GLiP -P✓1�------------------------------- - -------------------------------------- Phone --s.z� a_ 91 Installation will serve: Residence IK Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j-_-_ Number of bedrooms __S2_ Number of baths --4._ Lot size --------- x.___f _______________________ Water Supply: Public system ❑ Community system ❑ Private ( Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-..___._--___-.___.) No $J New Construction: YesX No ❑ FHA/VA: Yes ❑ NoA 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---d�--,---Distance from foundation__/P l__.______-Material---A/. .. _____________ No. of comartments_ �_._. P ---------._Size------��-_X_.?-------------Liquid depth------Y1 - --- ---------Capacity----Zc1-4Q---- -_- ti Disposal Field: Distance from nearest well.__s 0.......Distance from foundation----- -Q__�-------Distance to nearest lot line-----6 ------ Number of lines---------- -- ------ -- Length of each lire-----6D..-----------------.Width of trench----- � --_-------------------- Type of filter material--_ ......Depth of filter material-----/g.........Total length_____0--------_;--- -___.-------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------.Distance to nearest lot line--___-.____.____ ❑ Number of pits----------------------Lining material----------.............Size: Diameter----------------------- Depth.--.-- ....------------.--- Cesspool: Distance from nearest wefl-------_----...__Distance from foundation---_----------------Lining material--------__._------------_-_,________- ❑ Size: Diameter----- -------------------------------Depth-------------------------------------------------..Liquid Capacity- •---------------gals. Priv Distance from nearest well - Distance from nearest building---------------------------------- ❑ Distance to nearest lot line rp Remodelingand/or repairing (describe)-------------------------------------------------------------------------------------------------------------------------- ........--------------------• �1 --•-----------••-------------------------------------------------------------------------------------------------------------------------------------------- - ---11--------- ----- -- -- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 +he San Joaquin Local Health Dis+rict. (Signed}_ «- ------ - - ---------------- ----- -----------------------•----•------- -------- {Owner and/or Contractor) _Title (Plot plan, showing size of to , location of system in relation +o wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - ---_- ----------------------------------------------------------- DATE.... - -------------------- ---- REVIEWEDBY-------------------------- -- ------------------------ - ---------------- ------------ ------------- DATE----------------------------------------------------------- BUILDING -------------------------•----- ----BUILDING PERMIT ISSUED----------------- --------------------------------- ----------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations----------------------------------------------- ------------------------ --•---------------------------------------- --------------------------------------- k ---------- ---------------------- ------------- --- ---------- ---------------------------------------------------------- ---- -I--•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ��7 � `A FINAL INSPECTION BY:- - -----P--- Date.------ 4�/ �7---------- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.00. , .s—