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FFICE USE: -------------------------- jo3p.--- APPLICATION FOR-sANITATION PERMIT Permit No. .. ._.------ --------------I--- ------- -- ---------------------------- (Complef4'n Duplicate) - This Permit Expires 1 Year From Date IssuedDate Issued F , Application is hereby made to the San Joaquin Local Health District fora permit to construct and install.the,work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION___._�--�__ __._ Owner's Name. , /V-�5---------•------ --- -- - --- --------------------------------------------- Phone------------------------------------ Address- -•---------------------------------Address - ----------- -- c -�---- � � � -------------------------•----------------____-------------------------------- Con+Tacors. Name -�------ `, Phone Installation will serve: Residers IE pertment mouse-❑—Comm6r iFI–E] 'Tr—a-36 Cir ❑—M-511el .❑ Other ❑ Number of living units: :_._ Number of bedrooms 2:,umber of baths _`____ILot size,_-:4W--_ ______________________ Water Supply: Public system ommuni+y system ❑ Private ❑ Depth to Water Table ft. t Character of soil-to a depth of 3 feet: Sand ❑ Gravel ❑ San oam F] Clay Loam ❑` Clay-] Adob ardpan [I Previous Application Made'..: Ilf yes,date__-____--.__-___-) No New Construction: Yes ❑ No � A/VA: Yes ❑ No [�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`ar cesspool permitted if public sewer is available within 200 feet.) ' Septic Distance from nearest well_____�ance from foundations l�__-------__Ma.eria)_.�_(G------ C ________-_. _ No. of compartments'1._�---------------Size_�f -----Liquid depth--�----------------Capacity-Jc�X ------ Disposal d: Distance from nearest well__________ ------Distance from foundation., -r F• _____-Distance to nearest lot line__-47�l_____ Number of?.lines__--I----j-_____`__._ _____ ___. Length of each line_____ _6 -- -------- - of french....>�--- Type.of filter. material___1�2_ li Dept of filter material__ �{'_'�-------Total length--------- d ------------_------- 0 Seepage • Distance to nearest - w -~r:_,______:Distance m foundation__/�__/----Distance to nearest lot line�------- r f_-_ Number of. its-__ __ ____.________ nngmaterra-- G�____.Size: Dept fliameter_��___-__-.-___Depthp2p�r�_,iJ'JG>s-r, %Ai .1 i Cesspool: Distance from nearest well______,__-___-__Distance from foundation_._-_-___________,.Lining material______________________________.-.__ + ❑ Size: Diameter Depth \1 ----=----------------------------Liquid Capacity---------------•------------gals . i I` Privy: Distance f-rbm nearest well----..-------------------------------------------Distance from nearest building_________________._____-_.-_--------------. s = -Distance to nearest lot Ione----- ------------------------------------------- ------ RemodeGn and/or r'e airin describe -----------------_,'" ""! rl --------------------••---•---•------------------•--1------------------------------------------------------------------------ --------------- - - ------- ---- ----------- ------------------------------------ -------------------------- -----------------------------•--•------------ --------------------------------------------------- --;------------ --------------------------------- - ------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and tha# the work will be done in accordance with San Joaquin County ordinances. State laws, n r les and ' lati s of the San Joaquin Local Health District. (Signed) r d w � --------- -----------------'--�- - --------- ----------•--•---- ---- --(Owner and/or Contractor) f' a sy�� -'-- �i(1 ----------- ------------- (Title) (Plot plan,-showing size of I` , location of system.in relation,to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE;ONLY APPLICATION ACCEPTED BY_ -�GoJ --------- DATE ------------------------------ REVIEWED ---� - - as -G -- -- ------- REVIEWEDBY-------------------------------------- --------------------------------------- --------------------------------------------- DATE------- ------------•------------------------•- `---------- BUILDINGPERMIT ISSUED----- ----•--------------------------------------------------–_-------------------------------------- DATE--------------------------- -------------------- Alterations and/ re�c}mme da lon S'-�2s !_c_-- _ 4 'K � -------------- - f. ------ -------------------------- S— r —` ' �'rid ��i --------------------------------------------------------------.------------------------------------------------------------------------------------------- ------------------------------------------ --------------------- FINAL INSPECTION BY:------- .- Date ��-- �3- ---6 ----------------- '{SAN JOAQUIN LOCAL HEALTH DISTRICT • 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-S9 3M 3-'63 P.P.CC.